TY - JOUR
T1 - Tocilizumab in grade 4 hepatitis secondary to immune checkpoint inhibitor
T2 - a case report and review of the literature
AU - Ali, Syed B.
AU - Vembar, Preethi
AU - Sukumaran, Shawgi
AU - Gunawardane, Dimuth
AU - Hughes, Tiffany
AU - Smith, Anthony
PY - 2023/10/1
Y1 - 2023/10/1
N2 - First- and second-line treatments for immune checkpoint inhibitor-related hepatotoxicity (IRH) are well established; however, evidence for third-line therapies is limited. We present a 68-year-old female with relapsed metastatic non-small-cell lung carcinoma despite multiple treatments. A fortnight after the second cycle of CTLA-4 inhibitor immunotherapy, she developed scleral icterus and mild jaundice with significant elevation in liver enzymes. A diagnosis of IRH was made, and despite corticosteroids, mycophenolate and tacrolimus, liver enzymes continued to worsen. One infusion of tocilizumab was given, which resulted in a remarkable improvement. Prednisolone and tacrolimus were then tapered over the ensuing months, and mycophenolate was continued. Given the rapid improvement in liver enzymes with tocilizumab, this treatment should be considered as a third-line treatment in IRH. Plain language summary A lady had cancer of the lung. A new medication was started but the liver became damaged. Three medications were tried to help the liver. None of these worked. Another drug (called tocilizumab) was tried and worked. The liver got better. Tweetable abstract A case report on the utility of tocilizumab as a third-line treatment for refractory grade 4 hepatitis as a complication of immune checkpoint inhibitor therapy.
AB - First- and second-line treatments for immune checkpoint inhibitor-related hepatotoxicity (IRH) are well established; however, evidence for third-line therapies is limited. We present a 68-year-old female with relapsed metastatic non-small-cell lung carcinoma despite multiple treatments. A fortnight after the second cycle of CTLA-4 inhibitor immunotherapy, she developed scleral icterus and mild jaundice with significant elevation in liver enzymes. A diagnosis of IRH was made, and despite corticosteroids, mycophenolate and tacrolimus, liver enzymes continued to worsen. One infusion of tocilizumab was given, which resulted in a remarkable improvement. Prednisolone and tacrolimus were then tapered over the ensuing months, and mycophenolate was continued. Given the rapid improvement in liver enzymes with tocilizumab, this treatment should be considered as a third-line treatment in IRH. Plain language summary A lady had cancer of the lung. A new medication was started but the liver became damaged. Three medications were tried to help the liver. None of these worked. Another drug (called tocilizumab) was tried and worked. The liver got better. Tweetable abstract A case report on the utility of tocilizumab as a third-line treatment for refractory grade 4 hepatitis as a complication of immune checkpoint inhibitor therapy.
KW - CTLA-4 inhibitor
KW - immune checkpoint inhibitor-related hepatitis
KW - immune checkpoint inhibitors
KW - immune-related adverse effects
KW - tocilizumab
UR - http://www.scopus.com/inward/record.url?scp=85169292041&partnerID=8YFLogxK
U2 - 10.2217/imt-2023-0085
DO - 10.2217/imt-2023-0085
M3 - Article
C2 - 37401340
AN - SCOPUS:85169292041
SN - 1750-743X
VL - 15
SP - 1125
EP - 1132
JO - Immunotherapy
JF - Immunotherapy
IS - 14
ER -