Acute liver injury associated with rechallenge with a different type of immune checkpoint inhibitor in a patient with a history of severe immune-related adverse events

Abstract

A 59-year-old man with advanced non-small-cell lung cancer (NSCLC) developed acute liver injury 35 days after receiving pembrolizumab. There was no evidence of another cause for the hepatitis. Liver biopsy revealed interface hepatitis and CD8-positive lymphocyte infiltration in the portal area and liver parenchyma. Pembrolizumab-induced liver injury, which is a type of immune-related adverse event (irAE), was diagnosed. He received a combination of corticosteroid and mycophenolate mofetil (MMF), as his condition was refractory to corticosteroids. He then he received atezolizumab treatment for NSCLC. Eight days after initiation of atezolizumab, he relapsed. As the histological findings were similar to the first liver biopsy, he was diagnosed with atezolizumab-induced liver injury. A combination of corticosteroid and MMF achieved remission. The advisability of rechallenging with immune checkpoint inhibitors in patients with a history of severe irAE is controversial. We recommend careful monitoring of such patients to ensure early detection of irAE.