Table 1:
Clinical features of 60 patients with abnormal liver tests in the setting of immune checkpoint inhibitor therapy
| Age range (mean) | 28–85 years (61 yr) |
|---|---|
| Male: Female | 29:31 |
| Malignancy | |
| Melanoma | 41 |
| Non-small cell lung carcinoma | 5 |
| Gastrointestinal adenocarcinoma | 4 |
| Pancreatobiliary adenocarcinoma | 3 |
| GYN malignancy | 2 |
| Glioblastoma | 3 |
| Acute myeloid leukemia | 1 |
| Cutaneous squamous cell carcinoma | 1 |
| Immune checkpoint inhibitor therapy | |
| Anti-PD1 only | 15 |
| Anti-CTLA4 only | 4 |
| Combination Anti-PD1/Anti-CTLA4 | 20 |
| Sequential Anti-PD1 and Anti-CTLA4 | 8 |
| Checkpoint inhibitor with other therapy | 13 |
| Median days on ICI therapy (range) | 78 (12–917) |
| Grade of liver toxicity (CTCAE) | |
| 1 | 2 |
| 2 | 5 |
| 3 | 44 |
| 4 | 9 |
| Pattern of liver enzyme abnormality | |
| Hepatitic | 30 |
| Cholestatic | 24 |
| Mixed | 6 |
| Radiologic modalities (n=59) | |
| CT or PET CT only | 42 |
| Ultrasound and CT | 9 |
| Ultrasound only | 3 |
| MRCP or ERCP (with or without other modalities) | 5 |
| Radiologic findings (n=59) | |
| No relevant liver findings | 30 |
| Hepatic metastases | 15 |
| Bile duct dilatation or narrowing | 5 |
| Gallbladder thickening | 5 |
| Steatosis | 5 |
| Portal edema | 2 |
| Cirrhosis | 1 |
| Duration of steroids | |
| Not given | 8 |
| Less than 1 month | 19 |
| 1 to 3 months | 14 |
| Greater than 3 months* | 18 |
| Uncertain | 1 |
| Secondary immunosuppression* | 12 |
| Median days until resolution of LFTs (range) | 44 (2–302) |
| Outcome | |
| Alive without disease | 18 |
| Alive with disease | 18 |
| Dead of disease | 24 |
ICI: Immune checkpoint inhibitor; CTCAE: Common terminology criteria for adverse events; LFT: Liver Function Test
*
Two patients required steroids and secondary immunosuppression for concurrent Immune mediated colitis.