Table 4.
Clinical characteristics of ChILI cases from three centres.
| NUH (n = 38) 2011–2021 |
CUH (n = 25) 2014–2021 |
LTHT (n = 36) 2018–2021 |
Total (n = 99) | |
|---|---|---|---|---|
| Cancer, n (%) | ||||
| Malignant melanoma | 35 (92.1) | 20 (80) | 32 (88.9) | 87 (87.9) |
| Advanced RCC | 3 (7.9) | 5 (20) | 4 (11.1) | 12 (12.1) |
| CPI regimen in melanoma, n (%) | ||||
| Ipilimumab + nivolumab followed by nivolumab | 29 (82.9) | 11 (55) | 21 (65.6) | 61 (70.1) |
| Ipilimumab | 2 (5.7) | 1 (5) | 0 | 3 (3.4) |
| Nivolumab | 0 | 2 (10) | 2 (6.3) | 4 (4.6) |
| Pembrolizumab | 3 (8.6) | 4 (20) | 6 (18.8) | 13 (14.9) |
| Adjuvant pembrolizumab | 1 (2.9) | 2 (10) | 3 (9.4) | 6 (6.9) |
| CPI regime in RCC, n (%) | ||||
| Ipilimumab + nivolumab followed by nivolumab | 2 (66.7) | 2 (40) | 3 (75) | 7 (58.3) |
| Nivolumab | 1 (33.3) | 3 (60) | 1 (25) | 5 (41.7) |
| Previous exposure to CPI, n (%) | 2 (5.3) | 3 (12) | 6 (16.7) | 11 (11.1) |
| Previous exposure chemo/targeted therapy, n (%) | 6 (15.8) | 7 (28) | 3 (8.3) | 16 (16.2) |
| Median number of cycles prior to ChILI (IQR) | 3 (2.4) | 2 (1.3) | 3 (2.4) | 3 (2.4) |
| CTCAE hepatotoxicity grade, n (%) | ||||
| 2 (moderate) | 1 (2.6) | 0 | 0 | 1 (1) |
| 3 (severe) | 28 (73.7) | 22 (88) | 28 (77.8) | 78 (78.8) |
| 4 (life-threatening) | 9 (23.7) | 3 (12) | 8 (22.2) | 20 (20.2) |
| EWG severity grade, n (%) | ||||
| Mild | 11 (28.9) | 18 (72) | 16 (44.4) | 45 (45.5) |
| Moderate | 27 (71.1) | 7 (28) | 20 (55.6) | 54 (54.5) |
| Severe | 0 (0) | 0 (0) | 0 | 0 (0) |
| Developed jaundice (total bilirubin ≥ twofold), n (%) | 2 (5.3) | 2 (8) | 6 (16.7) | 10 (10.1) |
| Pattern | ||||
| Hepatocellular | 22 (57.9) | 12 (48) | 19 (52.8) | 53 (53.5) |
| Mixed | 11 (28.9) | 8 (32) | 10 (27.8) | 29 (29.3) |
| Cholestatic | 5 (13.2) | 5 (20) | 7 (19.4) | 17 (17.2) |
| Median RUCAM score (IQR) | 7(6.8) | 7 (5.8) | 8 (7.9) | 8 (6.8) |
| Treatment of ChILI, n (%) | ||||
| Corticosteroids alone | 34 (89.5) | 21 (84) | 19 (52.8) | 74 (74.7) |
| Corticosteroids + MMF | 2 (5.3) | 2 (8) | 11 (30.6) | 15 (15.2) |
| Corticosteroids + MMF + tacrolimus | 0 | 0 (0) | 6 (16.7) | 6 (6.1) |
| None | 2 (5.3) | 2 (8) | 0 (0) | 4 (4) |
| Patients with concurrent other irAE, n (%) | 22 (57.9) | 13 (52) | 23 (63.9) | 58 (58.6) |
| Most common concurrent irAE, n (%) | ||||
| Thyroiditis | 15 (39.5) | 3 (12) | 2 (5.6) | 20 (20.2) |
| Colitis | 8 (21.1) | 3 (12) | 9 (25) | 20 (20.2) |
| Skin rash | 5 (13.2) | 3 (12) | 6 (16.7) | 14 (14.1) |
| Adrenalitis | 0 | 1 (4) | 8 (22.2) | 9 (9.1) |
| Hypophysitis | 1 (2.6) | 2 (8) | 2 (5.6) | 5 (5.1) |
ChILI, checkpoint inhibitor-induced liver injury; CPI, checkpoint inhibitors; CTCAE, Common Terminology Criteria for Adverse Events V5.0;8 CUH, Cambridge University Hospital NHS Foundation Trust; EWG, Expert Working Group definitions and grading in drug-induced liver injury;12 irAE, immune-related adverse events; LTHT, Leeds Teaching Hospitals NHS Trust; MMF, mycophenolate mofetil; NUH, Nottingham University Hospitals NHS Trust; RCC, renal cell carcinoma.