Retreatment with checkpoint inhibitors feasible after immune-related hepatitis resolution

In patients who discontinued a checkpoint inhibitor (CPI) due to severe immune-related hepatitis, retreatment with the same or a different CPI is feasible after resolution of the liver injury and does not lead to recurrence in up to 65 percent of patients, according to a study.

The study included 23 cancer patients who previously developed grade 3 or 4 immune-related hepatitis and were retreated with CPIs.

Of the patients, 20 (87 percent) had received a single CPI and three (13 percent) were given anti-PD1 plus anti-CTLA-4; 19 (82.6 percent) also received steroids. The most frequent cancers were lung cell (n=7) and urinary tract (n=6). All patients discontinued immunotherapy following the incidence of severe immune-related hepatitis.

After a median time of 10 weeks (range, 1–54) from the severe immune-related hepatitis, patients were mainly retreated with the same CPI (n=18, 78.3 percent). Fifteen patients (65.2 percent) did not experience recurrence of the immune-related liver injury after retreatment.

On the other hand, among the eight (34.8 percent) patients who developed recurrence, five had grade 3 and three had grade 4. Six (75 percent) patients had either an underlying autoimmune disease or antinuclear antibodies (ANAs) ≥1/80 (75 percent vs 26.7 percent; p=0.037).

Recurrence did not occur among patients with previously grade 4 immune-related hepatitis, while those who experienced recurrence tended to present better oncological prognosis.

Overall, 19 (82.6 percent) patients required permanent discontinuation of CPIs, with cancer progression as the main reason for discontinuation (n=9, 47.8 percent).