Unit:
Κατεύθυνση Νεοπλασματική Νόσος στον Άνθρωπο: Έρευνα και Κλινικοπαθολογοανατομική Προσέγγιση στα Πλαίσια της Εξατομικευμένης Ιατρικής (Διάγνωση και Στοχευμένη Θεραπεία)Library of the School of Health Sciences
Supervisors info:
Στρατηγούλα Σακελλαρίου, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Κωνσταντίνα Τηνιακού, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Δέσποινα Μυωτέρη, Επίκουρη Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Η τοξικότητα της ανοσοθεραπείας στο ήπαρ
Translated title:
Toxicity in the liver by immunotherapy
Summary:
Immunotherapy is nowadays a useful therapeutic option in clinical practice for the treatment of advanced neoplasms. The most common immunotherapeutic agents are immune checkpoint inhibitors (ICIs), which have proven their safety and efficacy.
Hepatotoxicity is one of the immune-mediated adverse effects associated with the administration of immunotherapy. Although it is a relatively common side effect, it is usually mild. However, it can prove to be dangerous, as it distracts attention, being asymptomatic or with non-specific findings, while rarely fulminant hepatitis can occur with devastating consequences. The laboratory and imaging tests, as well as the results of the histological examination of the liver biopsy contribute to the diagnosis, of this adverse event but are not pathognomonic. They may also be influenced by the patient's history, especially in cases with an underlying liver pathology.
The management of patients with immune-mediated hepatotoxicity is difficult, as it involves cases with various comorbidities. Corticosteroids are the first-line treatment option, with concomitant discontinuation of immunotherapy. However, if corticosteroid resistance is observed, a second-line immunosuppressant is necessary. Finally, the re-introduction of immunotherapy in patientswho previously developed immune-mediated hepatitis is possible; however a risk-benefit assessment should precede. The complex pattern of the initial problem, the comorbidities, and the management of the patient requires multidisciplinary collaboration
. Finally, due to the increased use of immunotherapeutic regimens, a raiseof the immune-mediated toxicity is expected.Thus, further study of the common characteristics of these patients is necessary to establish the most appropriate algorithm for diagnosis and management.
Main subject category:
Health Sciences
Keywords:
Immunotheraphy, PD-1, PD-L1, CTLA-4, Cancerimmunotherapy, Liver, Adverseevents, Adverseeffects, Toxicity, Toxicevents, Safety, Hepatotoxicity
Number of references:
168
