Outcomes of immunotherapy-related hepatotoxicity from a multi-disciplinary toxicity team

Christopher Fan, Ahyoung Kim, Sean Li, Jarushka Naidoo, Laura C. Cappelli, Julie R. Brahmer, Robert A. Anders, Amy K. Kim

Research output: Contribution to journalArticlepeer-review


Background: Despite the efficacy of immune checkpoint inhibitors (ICIs), adverse events including hepatotoxicity limit their ongoing use. We investigated the outcomes and management of patients with immune-mediated hepatitis (IMH) and clinical predictors of toxicity resolution. Methods: Patients referred to our multidisciplinary immunotherapy-related toxicity group from August 2017 to December 2020 for IMH were evaluated. Toxicity was defined according to CTCAEv4.0. IMH resolution was defined as liver enzyme normalization after steroid initiation. Results: Thirty-three patients were included in the study, 62% female, and 71% Caucasian. The most common ICI used was PD-1/PD-L1 (76%). Peak IMH occurred at a median of 89 [45,193] days, for which most patients received 1–2 mg/kg/day prednisone equivalent with 35% requiring MMF. Median follow-up was 123 [33,472] days with IMH resolution seen in 48% of patients at a median of 111 [41,214] days. While high-dose steroid use was not associated with IMH resolution, liver enzyme improvement one week after steroids predicted resolution in univariate analysis (p = 0.041). All 11 patients without IMH resolution died from cancer progression or complications with three patients having acute liver failure. Available liver biopsies showed bile duct injury, with varying degrees of portal and lobular inflammation. Conclusion: IMH improvement one week after steroid initiation may predict ultimate IMH resolution.

Original languageEnglish (US)
Pages (from-to)877-883
Number of pages7
JournalJournal of Cancer Research and Clinical Oncology
Issue number2
StatePublished - Feb 2023


  • Checkpoint inhibitor
  • Drug toxicity
  • Hepatitis
  • immunotherapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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