Immune Checkpoint Inhibitors Induced Hepatotoxicity; Gastroenterologists’ Perspectives

Abstract

BACKGROUND: Immune checkpoint inhibitors (ICIs) have promising clinical activity and are essential medications for patients with several malignancies. However, by deranging the immune system, these novel agents could lead to immune-related adverse events (IRAEs). Hepatotoxicity with checkpoint inhibitors usually results in acute hepatitis or drug-induced liver injury. METHODS: This review article discusses the recent clinical evidence available regarding checkpoint inhibitor-induced hepatitis and reviews an approach to their diagnosis and management. RESULTS: The rate of liver injury with ICIs varies between different checkpoint inhibitors. It has been reported that the incidence of various grades of autoimmune hepatotoxicity with CTLA-4 inhibitors is between 3%-9%.The clinical characteristics of ICIs-induced hepatotoxicity are quite heterogeneous but they are usually in line with an autoimmune induced liver injury. Management of severe ICIs-related hepatitis should consist of termination of the ICI and treatment with corticosteroids. CONCLUSION: ICIs have improved patients’ outcomes with different forms of malignancy; however, ICIs-related liver damage is a clinically significant entity in these patients. All patients should be monitored carefully for IRAEs while undergoing treatment with ICIs.