Tocilizumab in grade 4 hepatitis secondary to immune checkpoint inhibitor: a case report and review of the literature

Syed B. Ali, Preethi Vembar, Shawgi Sukumaran, Dimuth Gunawardane, Tiffany Hughes, Anthony Smith

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1125-1132
Number of pages8
JournalImmunotherapy
Volume15
Issue number14
DOIs
Publication statusPublished - 1 Oct 2023

Keywords

  • CTLA-4 inhibitor
  • immune checkpoint inhibitor-related hepatitis
  • immune checkpoint inhibitors
  • immune-related adverse effects
  • tocilizumab

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