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A multicenter characterization of hepatitis associated with immune checkpoint inhibitors.

Publication ,  Journal Article
Patrinely, JR; McGuigan, B; Chandra, S; Fenton, SE; Chowdhary, A; Kennedy, LB; Mooradian, MJ; Palmeri, M; Portal, D; Horst, SN; Scoville, EA ...
Published in: Oncoimmunology
February 8, 2021

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.

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Published In

Oncoimmunology

DOI

EISSN

2162-402X

Publication Date

February 8, 2021

Volume

10

Issue

1

Start / End Page

1875639

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Neoplasm Recurrence, Local
  • Melanoma
  • Male
  • Infant, Newborn
  • Immune Checkpoint Inhibitors
  • Humans
  • Hepatitis
  • 3211 Oncology and carcinogenesis
  • 3204 Immunology
 

Citation

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Patrinely, J. R., McGuigan, B., Chandra, S., Fenton, S. E., Chowdhary, A., Kennedy, L. B., … Johnson, D. B. (2021). A multicenter characterization of hepatitis associated with immune checkpoint inhibitors. Oncoimmunology, 10(1), 1875639. https://doi.org/10.1080/2162402X.2021.1875639
Patrinely, J Randall, Ben McGuigan, Sunandana Chandra, Sarah E. Fenton, Akansha Chowdhary, Lucy B. Kennedy, Meghan J. Mooradian, et al. “A multicenter characterization of hepatitis associated with immune checkpoint inhibitors.Oncoimmunology 10, no. 1 (February 8, 2021): 1875639. https://doi.org/10.1080/2162402X.2021.1875639.
Patrinely JR, McGuigan B, Chandra S, Fenton SE, Chowdhary A, Kennedy LB, et al. A multicenter characterization of hepatitis associated with immune checkpoint inhibitors. Oncoimmunology. 2021 Feb 8;10(1):1875639.
Patrinely, J. Randall, et al. “A multicenter characterization of hepatitis associated with immune checkpoint inhibitors.Oncoimmunology, vol. 10, no. 1, Feb. 2021, p. 1875639. Pubmed, doi:10.1080/2162402X.2021.1875639.
Patrinely JR, McGuigan B, Chandra S, Fenton SE, Chowdhary A, Kennedy LB, Mooradian MJ, Palmeri M, Portal D, Horst SN, Scoville EA, Long GV, Shi C, Mehnert JM, Sullivan RJ, Salama AK, Sosman JA, Menzies AM, Johnson DB. A multicenter characterization of hepatitis associated with immune checkpoint inhibitors. Oncoimmunology. 2021 Feb 8;10(1):1875639.

Published In

Oncoimmunology

DOI

EISSN

2162-402X

Publication Date

February 8, 2021

Volume

10

Issue

1

Start / End Page

1875639

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Neoplasm Recurrence, Local
  • Melanoma
  • Male
  • Infant, Newborn
  • Immune Checkpoint Inhibitors
  • Humans
  • Hepatitis
  • 3211 Oncology and carcinogenesis
  • 3204 Immunology