A Case of Liver Injury as an Immune-related Adverse Event in Squamous Cell Carcinoma of the Lung with Successful Life-saving Treatment

Abstract

A patient with lung squamous cell carcinoma, cT4N3M1c (OSS), Stage IVB developed Grade 4 hepatic impairment after 2 cycles of carboplatin + paclitaxel + nivolumab + ipilimumab as first-line chemotherapy. Clinically, an immune-related adverse event (irAE) was suspected and pulse therapy with 1 g methylprednisolone for 3 days was administered twice, followed by prednisolone 100 mg/day and mycophenolate mofetil 2000 mg/day, resolving the hepatic impairment. Immune checkpoint inhibitors can cause severe irAEs, as in the present case where cytotoxic chemotherapy combined with anti-PD-1 and anti-CTLA-4 antibodies caused Grade 4 irAE liver injury, which was successfully treated with steroids and immunosuppressants.