Table 3:
Clinical features in 60 patients with suspected immune checkpoint inhibitor liver injury by histologic pattern
| Hepatitic Pattern (n=36) | Cholangitic pattern (n=16) | Steatotic pattern (n=4) | Mild and nonspecific changes (n=4) | |
|---|---|---|---|---|
| Checkpoint therapy | ||||
| Anti-PD1 only | 7 | 5 | 2 | 1 |
| Anti-CTLA4 only | 4 | 0 | 0 | 0 |
| Combination ICI | 13 | 7 | 0 | 0 |
| Sequential ICI | 5 | 1 | 1 | 1 |
| ICI and other | 7 | 3 | 1 | 2 |
| Pattern of LFTs | ||||
| Hepatitic | 24 | 2 | 1 | 3 |
| Cholestatic | 9 | 12 | 3 | 0 |
| Mixed | 3 | 2 | 0 | 1 |
| Grade of liver toxicity (CTCAE) | ||||
| 1 | 0 | 1 | 1 | 0 |
| 2 | 4 | 1 | 0 | 0 |
| 3 | 25 | 12 | 3 | 4 |
| 4 | 7 | 2 | 0 | 0 |
| Radiologic findings | ||||
| Normal | 22 | 5 | 3 | 1 |
| Hepatic metastases | 7 | 7 | 0 | 1 |
| Bile duct dilatation/narrowing | 1 | 4 | 0 | 0 |
| Gallbladder thickening | 2 | 2 | 1 | 0 |
| Duration of steroids | ||||
| Not given | 3 | 2 | 2 | 1 |
| < 1 month | 10 | 6 | 1 | 2 |
| 1 to 3 months | 10 | 4 | 0 | 0 |
| > 3 months | 12 | 4 | 1 | 1 |
| Uncertain | 1 | 0 | 0 | 0 |
| Secondary immunosuppression | 8a | 2 | 1 | 1 |
| Median days to resolution of LFTs (range) | 52 (2–160) | 47 (14–210) | 119 (59–302) | 26 (20–267) |
| Outcome | ||||
| Alive without disease | 11 | 4 | 2 | 1 |
| Alive with disease | 12 | 4 | 1 | 1 |
| Dead of disease | 13 | 8 | 1 | 2 |
| Alternative explanation for LFTs | 2b | 5c | 0 | 1b |
ICI: Immune checkpoint inhibitor; CTCAE: Common terminology criteria for adverse events; LFT: Liver Function Test
a
2 patients received infliximab for concurrent colitis
b
Received cytotoxic chemotherapy
c
3 patients received cytotoxic chemotherapy; 2 patients had biliary obstruction from tumor.