Can immunotherapy challenge again after severe immune-related hepatitis?

*Only for medical professionals to read and reference for 1 minute a day, to give you professional "talks" in the tumor circle! (If you need the original text of the literature, you can add the editor's WeChat yxj_oncology to get it) ▎Clinical question: What is the outcome of patients who re-accepted immunotherapy after remission of severe immune-related hepatitis? Liver injury associated with immunotherapy is a relatively common immune-related adverse event that requires permanent discontinuation of immune checkpoint inhibitors (ICIs) in severe cases
.

A prospective, multicenter, non-interventional study from Clinical Gastroenterology H presents the results of a cohort of patients who re-entered immunotherapy after remission of severe immune-related hepatitis
.

Screenshot of the study publication▎Research protocol: The study included all cancer patients in three university hospitals who were continuously treated with ICIs and had previously suffered from grade 3 or 4 immune-related hepatitis.
A total of 23 developed severe immune-related hepatitis: 20/23 (87.
0%).
) received a single ICI, and 3/23 (13.
0%) received anti-PD-1 plus anti-CTLA-4
.

The most common cancers were lung cell carcinoma and urinary tract cancer (7 and 6, respectively)
.

Immunotherapy was discontinued in all cases
.

Nineteen (82.
6%) received steroid therapy concurrently
.

After a median time of 10 weeks (range, 1-54), patients were re-treated with the same ICI (18/23, 78.
3%) primarily after remission of severe immune-related hepatitis
.

▎Main findings: 15 patients (65.
2%) had no recurrence of immune-related hepatitis after retreatment
.

Among 8 patients (34.
8%) who developed immune-related hepatitis recurrence, 5/8 were grade 3 and 3/8 were grade 4
.

Six (75%) had underlying autoimmune disease or antinuclear antibodies (ANAs) ≥1/80 (75% vs 26.
7%, p=0.
037)
.

Patients with previous grade 4 hepatitis did not relapse, and those who did tend to have better oncological outcomes
.

Overall, 19 (82.
6%) patients required permanent ICI discontinuation, with cancer progression being the main reason for discontinuation (9/19, 47.
8%)
.

▎Deficiencies and Prospects: In conclusion, after the development of severe immune-related hepatitis, re-treatment with ICIs is a feasible option even with the same ICIs, and in up to 65% of patients, liver injury does not recur after re-treatment
.

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