Compromise or not? A case report of successful treatment of pembrolizumab‐induced hepatitis in a patient with non‐small cell lung cancer with low‐dose methylprednisolone and bicyclol
Open Access
- 7 May 2020
- journal article
- research article
- Published by Wiley in Thoracic Cancer
- Vol. 11 (7), 2023-2030
- https://doi.org/10.1111/1759-7714.13463
Abstract
Pembrolizumab, an anti‐programmed cell death protein 1 (PD‐1) antibody, has been shown to improve survival in patients with non‐small cell lung cancer (NSCLC) with high expression of programmed death‐ligand 1 (PD‐L1). Corticosteroids are the mainstay for most high‐grade immune‐related adverse events (irAEs) such as pembrolizumab‐induced hepatitis. However, the dose and duration of corticosteroid therapy are not well defined. The objective of this case report was to describe a new treatment pattern for severe immune checkpoint inhibitor‐associated hepatitis. Here, we report the case of a patient with metastatic lung adenocarcinoma who developed grade 3 immunotherapy‐induced hepatitis after the first cycle of pembrolizumab. Alanine aminotransferase (ALT) levels peaked at 233 U/L. Hepatitis was alleviated after the administration of methylprednisolone. Therefore, we retreated the patient with pembrolizumab. However, aminotransferase levels increased again after the initiation of low‐dose methylprednisolone or the reuse of pembrolizumab. Finally, hepatitis was controlled with low‐dose methylprednisolone plus bicyclol, a Chinese hepatoprotective agent. Although the patient had been on low‐dose methylprednisolone therapy for about six months, he showed a prompt response. During this period, we also found a dramatic decrease in the neutrophil‐lymphocyte ratio (NLR), senescent T cells (CD8+CD28−CD57+), and myeloid‐derived suppressor cells (MDSCs) in the peripheral blood of the patient. To our knowledge, this is the first case report of successful management of grade 3 pembrolizumab‐induced hepatitis with a combination of low‐dose corticosteroids and bicyclol. The durable clinical response and changes in blood biomarkers indicate that low doses of corticosteroids do not compromise the efficacy of immune checkpoint inhibitors (ICIs). Therefore, this case may provide a new treatment pattern for severe immunotherapy‐induced hepatitis.Keywords
Funding Information
- National Natural Science Foundation of China (81901570)
- Natural Science Foundation of Beijing Municipality (7204328)
- Natural Science Foundation of Beijing Municipality
- Wu Jieping Medical Foundation (320.6750.19094‐45)
This publication has 24 references indexed in Scilit:
- Peripheral immune-based biomarkers in cancer immunotherapy: can we realize their predictive potential?Journal for ImmunoTherapy of Cancer, 2019
- Functional systemic CD 4 immunity is required for clinical responses to PD ‐L1/ PD ‐1 blockade therapyEMBO Molecular Medicine, 2019
- Management of Immunotherapy-Related Toxicities, Version 1.2019, NCCN Clinical Practice Guidelines in OncologyJournal of the National Comprehensive Cancer Network, 2019
- High-dose glucocorticoids for the treatment of ipilimumab-induced hypophysitis is associated with reduced survival in patients with melanomaCancer, 2018
- Nivolumab plus Ipilimumab in Lung Cancer with a High Tumor Mutational BurdenThe New England Journal of Medicine, 2018
- Assessment of Concordance between 22C3 and SP142 Immunohistochemistry Assays regarding PD-L1 Expression in Non-Small Cell Lung CancerScientific Reports, 2017
- Managing toxicities associated with immune checkpoint inhibitors: consensus recommendations from the Society for Immunotherapy of Cancer (SITC) Toxicity Management Working GroupJournal for ImmunoTherapy of Cancer, 2017
- Management of toxicities from immunotherapy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-upAnnals of Oncology, 2017
- PD-L1 Immunohistochemistry Assays for Lung Cancer: Results from Phase 1 of the Blueprint PD-L1 IHC Assay Comparison ProjectJournal of Thoracic Oncology, 2017
- Pembrolizumab versus Chemotherapy for PD-L1–Positive Non–Small-Cell Lung CancerThe New England Journal of Medicine, 2016