Diagnosis and Treatment of irAE Cholangitis

Abstract

Immune checkpoint inhibitors (ICIs) are now the mainstay of cancer treatment, and management of immune-related adverse events (irAE) caused by ICIs is an essential skill.

Since our first report in 2017 of cholangitis after ICI treatment characterized by 1) unobstructed extrahepatic bile duct dilation, 2) diffuse extrahepatic bile duct wall thickening, 3) liver damage with predominance of biliary enzymes, 4) normal or low levels of antinuclear and antimitochondrial antibodies and IgG4, and 5) infiltration of CD8 positive T cells in the bile duct, a series of case reports of irAE cholangitis have appeared. However, the actual frequency of occurrence of cholangitis is relatively rare (0.05-0.7%). Thus no established diagnostic or therapeutic methods for this disease have established so far, making it a clinical problem. In this article, we review the concept of irAE cholangitis, diagnosis and treatment based on current knowledge, and discuss issues that need to be resolved in the future.