BRIEF RESEARCH REPORT article
Front. Oncol.
Sec. Cancer Immunity and Immunotherapy
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1683982
This article is part of the Research TopicNew Tumor Immune Checkpoints and Their Applications in Tumor ImmunotherapyView all 5 articles
Evaluating the Impact of Immune Checkpoint Inhibitors on Liver Steatosis and Function: A Retrospective Cohort Analysis
Provisionally accepted
- Vanderbilt University Medical Center, Nashville, United States
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Background: Immune checkpoint inhibitors (ICIs) are an essential class of immunotherapy drugs for cancer, but their impact on chronic inflammatory conditions remains unclear. Liver attenuation, a non-invasive measure of liver steatosis on CT, offers a way to assess liver inflammation. This study evaluates the impact of ICI therapy on liver attenuation and liver enzyme levels in cancer patients, building on prior research with a larger cohort. Methods: We conducted a retrospective cohort study of 164 cancer patients treated with ICIs at Vanderbilt University Medical Center between 2017 and 2022. Liver attenuation and enzyme levels (total bilirubin, AST, ALT, alkaline phosphatase) were analyzed before and after ≥1 year of ICI therapy. Clinical factors such as weight change, liver metastasis, and steroid use were also assessed. Hepatic adverse events were characterized using CTCAE v5.0 criteria. Results: No significant changes in liver attenuation were observed from baseline to post-treatment (59.86 ± 8.07 HU vs 59.38 ± 8.36 HU, p = 0.42). Liver enzyme levels also remained stable. Post-treatment liver abnormalities occurred in 23 patients (14.0%), with most being Grade 1 elevations (11.0%). Increased body weight was significantly associated with lower liver attenuation (p < 0.0001), and liver metastasis correlated with higher total bilirubin (p < 0.001) and AST levels (p < 0.01). Conclusion: ICIs did not significantly change liver attenuation or enzyme levels, suggesting they may not exacerbate liver fat deposition or subclinical injury. Further research with additional imaging modalities is warranted.
Keywords: immune checkpoint inhibitor therapy, Immunotherapy, Liver steatosis, CT liver attenuation, Immune related adverse effects (irAEs)
Received: 11 Aug 2025; Accepted: 17 Sep 2025.
Copyright: © 2025 Schellhammer, Day, Fan, Ye, Planz and Johnson. 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: Douglas Johnson, douglas.b.johnson@vumc.org
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