ORIGINAL RESEARCH article
Front. Oncol.
Sec. Cancer Immunity and Immunotherapy
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1657332
This article is part of the Research TopicInflammation, Immunity, and Cancer: New Pathways Towards Therapeutic InnovationView all 9 articles
Treatment experience in managing severe immune-mediated hepatotoxicity induced by immune checkpoint inhibitors
Provisionally accepted
- Fourth Hospital of Hebei Medical University, Shijiazhuang, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Although multiple guidelines for managing severe immune-mediated hepatotoxicity (IMH) induced by immune checkpoint inhibitors (ICIs) were recommended, real-world research data regarding its clinical progression, treatment modalities, and outcomes remains scarce. Methods: This study was a retrospective, single-center investigation conducted at the Fourth Hospital of Hebei Medical University. A total of 379 patients with complete clinical records were enrolled in the Department of Immunology and Rheumatology at the Fourth Hospital of Hebei Medical University from January 2021 to July 2024. Binary logistic regression analysis was employed to identify potential risk factors associated with the development of severe IMH or infection during treatment. Receiver operating characteristic (ROC) curve analysis was further applied to determine the optimal cutoff values for the identified risk factors. Results: A total of 32 severe IMH patients were analyzed for risk factor association, the Eastern Cooperative Oncology Group Performance Status (ECOG PS) (P = 0.001) and oral traditional Chinese medicine (TCM) (P < 0.001) were independently associated with the incidence of severe IMH. Based on our experience with these 32 patients, we proposed a road map for management severe IMH patients: conventional applications of daily methylprednisolone sodium succinate with dose adjustment until 11 days, a liver biopsy to exclude vanishing bile duct syndrome for steroid resistant patients and subsequent plasma exchange (PE). Furthermore, the cumulative steroids use was identified as an independent risk factor for concurrent infection with a cutoff value of 1656mg (P = 0.024) in severe IMH patients. Conclusion: We investigated the risk factor of severe IMH and provided feasible treatment roadmap for severe IMH.
Keywords: Immune-mediated hepatotoxicity, immune checkpoint inhibitors, Immune-related adverse events, steroid, Plasma Exchange
Received: 01 Jul 2025; Accepted: 22 Sep 2025.
Copyright: © 2025 Cao, Zhang, Zhang, Zhao, Zhang and Guo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zhanjun Guo, zjguo5886@hebmu.edu.cn
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.