Liver

18 - Immunotherapy Induced Liver Injury: A Retrospective Analysis

Monday, October 8
2:45 PM - 2:55 PM
Location: Terrace Ballroom 2-3 (level 400)

Category: Liver
Vivek Bose, MD1, Daniel Sedhom, MD1, James Penn, MD1, Vinod Rustgi, MD, MPH1, Tina John, MBBS, MPH2, Avantika Mishra, MD1
1Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; 2Rutgers Robert Wood Johnson Medical Group, New Brunswick, NJ

Introduction: Immune checkpoint inhibitors are some of the newest treatment modalities for advanced and metastatic cancers. These therapies change the immune system so that the cancer cells are unable to evade T-cell immunity. The monoclonal antibodies such as Ipilimumab and Pembrolizumab are able block specific checkpoints of the signal transduction pathway to T-cell inhibition, thereby enhancing the antitumor T-cell activity. However, enhancing immune function with the goal of targeting the “immune evasion” characteristic of any cancer does not come without its risks. Immune related adverse events (irAEs) due to modifications to the immune system’s checkpoints is a natural consequence to eliminating T-cell inhibition, and this is a new and emerging subsection of Drug induced liver injury (DILI) that is becoming more prominent as these new antibody blocking immune therapies are being created.

Methods: We were able to evaluate 401 patients out of the Cancer Institute of New Jersey (CINJ) database of patient who had received one or a combination of the immunomodulatory drugs and based on chart review determined if they had elevated transaminases as an immune related adverse event (irAE).

Results: We found that a majority of the cases or immune related adverse events were caused by the CTLA-4 inhibitors and PD-1 inhibitors. Out of the 401 patient evaluated, there were 30 cases of irAEs, much higher than was initially anticipated based on previous studies. As seen in the table, the majority of the cases were due to a combination of these immune-modulators used to treat their respective cancers.

Discussion: As a retrospective analysis, we evaluated and discussed the potential advantages and disadvantages of immunotherapies. While the rate of hepatotoxic irAE using immunomodulators  has been known to be generally low, 1-7%, we have found that there have been numerous cases of patient requiring combination therapy for their specific cancers, and these combination therapies has increased the incidence of irAEs to more than 10% of those receiving treatment. As prescribing physicians we must maintain vigilance that as we prescribe these immune-modulators more readily, we must be cognizant of the adverse effects that they accompany, not only hepatitis but also diarrhea, colitis, and various endocrinopathies.


Disclosures:
Vivek Bose indicated no relevant financial relationships.
Daniel Sedhom indicated no relevant financial relationships.
James Penn indicated no relevant financial relationships.
Vinod Rustgi indicated no relevant financial relationships.
Tina John indicated no relevant financial relationships.
Avantika Mishra indicated no relevant financial relationships.

Vivek Bose

Vivek Bose
Rutgers Robert Wood Johnson Medical School
New Brunswick, New Jersey

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