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A multicenter characterization of hepatitis associated with immune checkpoint inhibitors
- Source :
- Oncoimmunology, article-version (VoR) Version of Record, OncoImmunology, Vol 10, Iss 1 (2021)
- Publication Year :
- 2021
- Publisher :
- Taylor & Francis, 2021.
-
Abstract
- Immune checkpoint inhibitors (ICI) predispose patients to immune-related adverse events (irAEs). Although hepatitis is a potentially lethal toxicity, the timing and outcomes have not been well described. In this retrospective study, patients from six international institutions were included if they were treated with ICIs and developed immune-related hepatitis. Patient and tumor characteristics, and hepatitis management and outcomes were evaluated. Of the 164 patients included, most were male (53.7%) with a median age of 63.0 years. Most patients had melanoma (83.5%) and stage IV disease (86.0%). Median follow-up was 585 days; median OS and PFS were not reached. The initial grade of hepatitis was most often grade 2 (30.5%) or 3 (45.7%) with a median time to onset of 61 days. Patients were most commonly asymptomatic (46.2%), but flu-like symptoms, including fatigue/anorexia (17.1%), nausea/emesis (14.0%), abdominal/back pain (11.6%), and arthralgias/myalgias (8.5%) occurred. Most patients received glucocorticoids (92.1%); the median time to improvement by one grade was 13.0 days, and the median time to complete resolution was 52.0 days. Second-line immunosuppression was required in 37 patients (22.6%), and steroid-dose re-escalation in 45 patients (27.4%). Five patients (3%) died of ICI-hepatitis or complications of hepatitis treatment. Ninety-one patients (58.6%) did not resume ICI; of 66 patients (40 grade 1/2, 26 grade 3/4) that were rechallenged, only 25.8% (n = 17) had recurrence. In this multi-institutional cohort, immune-related hepatitis was associated with excellent outcomes but frequently required therapy discontinuation, high-dose steroids, and second-line immunosuppression. Rechallenge was associated with a modest rate of hepatitis recurrence.
- Subjects :
- 0301 basic medicine
Male
medicine.medical_specialty
Nausea
medicine.medical_treatment
Immunology
Gastroenterology
Asymptomatic
survival
Hepatitis
immune checkpoint inhibitors
03 medical and health sciences
0302 clinical medicine
Internal medicine
medicine
Immunology and Allergy
Humans
Adverse effect
Melanoma
RC254-282
Original Research
Retrospective Studies
business.industry
Infant, Newborn
Neoplasms. Tumors. Oncology. Including cancer and carcinogens
toxicity
Retrospective cohort study
Immunosuppression
RC581-607
medicine.disease
Discontinuation
030104 developmental biology
Oncology
030220 oncology & carcinogenesis
Cohort
immune-related adverse events
Immunologic diseases. Allergy
medicine.symptom
Neoplasm Recurrence, Local
business
Research Article
Subjects
Details
- Language :
- English
- ISSN :
- 2162402X and 21624011
- Volume :
- 10
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Oncoimmunology
- Accession number :
- edsair.doi.dedup.....350c1b9732fb1b97f8808aae068cbfc4