[Liver injury induced by immune checkpoint inhibitor-therapy : Example of an immune-mediated drug side effect]

Risk Factors of Immune-Mediated Hepatotoxicity Induced by Immune Checkpoint Inhibitors in Cancer Patients: A Systematic Review and Meta-Analysis

Immune checkpoint inhibitors (ICIs) significantly improve survival, while immune-mediated hepatotoxicity (IMH) has been reported. To evaluate the incidence and potential risk factors of IMH among cancer patients treated by ICIs, PubMed/Medline, Web of Science, Cochrane, and Embase were searched before 30 March 2024 for systematic review and meta-analysis. Odds ratios (ORs) with 95% confidence intervals (CI) were calculated. Quality assessment was completed using the Newcastle-Ottawa scale. Of 1217 articles identified, 24 consisting of 9076 patients were included, with one study being prospective and the rest retrospective. The overall incidence of any grade IMH and grade ≥ 3 secondary to ICIs was 14% and 7%, respectively. The cholestatic pattern was more prevalent than the hepatocellular and mixed patterns. The meta-analysis revealed that ICI treatment was related to reduced risk of IMH in older patients (SMD: -0.18; 95% CI: -0.33 to -0.04), individuals with higher body mass index (WMD: -2.15; 95% CI: -3.92 to -0.38), males (OR: 0.44; 95% CI: 0.27 to 0.72), and patients with lung cancer (OR: 0.58, 95%CI 0.41 to 0.83). On the other hand, patients with liver metastasis (OR: 1.80; 95% CI: 1.47 to 2.20), history of ICI treatment (OR: 3.09; 95% CI: 1.21 to 7.89), diabetes (OR: 2.19; 95% CI: 1.36 to 3.51), chronic HBV (OR: 3.06; 95% CI: 1.11 to 8.46), and concomitant use of ICIs (OR: 8.73; 95% CI: 2.41 to 31.59) increased the risk of developing IMH. This study will provide clinicians with information on potentially high-risk groups for IMH, who need to be cautiously monitored for liver function when receiving immunotherapy.

Nomogram for Predicting Survival Post-Immune Therapy in Cholangiocarcinoma Based on Inflammatory Biomarkers

BACKGROUND

Immune therapy, especially involving PD-1/PD-L1 inhibitors, has shown promise as a therapeutic option for cholangiocarcinoma. However, limited studies have evaluated survival outcomes in cholangiocarcinoma patients treated with immune therapy. This study aims to develop a predictive model to evaluate the survival benefits of immune therapy in patients with cholangiocarcinoma.

METHODS

This retrospective analysis included 120 cholangiocarcinoma patients from Shulan (Hangzhou) Hospital. Univariate and multivariate Cox regression analyses were conducted to identify factors associated with survival following immune therapy. A predictive model was constructed and validated using calibration curves (CC), decision curve analysis (DCA), concordance index (C-index), and receiver operating characteristic (ROC) curves.

RESULTS

Cox regression analysis identified several factors as potential predictors of survival post-immune therapy in cholangiocarcinoma: treatment cycle (<6 vs ≥ 6 months, 95% CI: 0.119-0.586, P = 0.001), neutrophil-to-lymphocyte ratio (NLR <3.08 vs ≥ 3.08, 95% CI: 1.864-9.624, P = 0.001), carcinoembryonic antigen (CEA <4.13 vs ≥ 4.13, 95% CI: 1.175-5.321, P = 0.017), and presence of bone metastasis (95% CI: 1.306-6.848, P = 0.010). The nomogram model achieved good predictive accuracy with a C-index of 0.811. CC indicated strong concordance between the predicted and observed outcomes. Multi-timepoint ROC curves at 1, 2, and 3 years validated the model's performance (1-year AUC: 0.906, 2-year AUC: 0.832, 3-year AUC: 0.822). The multi-timepoint DCA curves also demonstrated a higher net benefit compared to extreme curves.

CONCLUSION

The nomogram model, incorporating key risk factors for cholangiocarcinoma patients post-immune therapy, demonstrates robust predictive accuracy for survival outcomes, offering the potential for improved clinical decision-making.

Liver Pathology Related to Onco-Therapeutic Agents

Oncotherapeutic agents can cause a wide range of liver injuries from elevated liver functions tests to fulminant liver failure. In this review, we emphasize a newer generation of drugs including immune checkpoint inhibitors, protein kinase inhibitors, monoclonal antibodies, and hormonal therapy. A few conventional chemotherapy agents are also discussed.

Treatment of patients with cancer using PD‑1/PD‑L1 antibodies: Adverse effects and management strategies (Review)

In 2020, there were an estimated 19.3 million new cancer cases and close to 10 million cancer deaths worldwide. Cancer remains one of the leading causes of death. In recent years, with the continuous improvement of our understanding of tumor immunotherapy, immunotherapeutics, such as immune checkpoint inhibitors, have gradually become a hot spot for tumor treatment. Amongst these, programmed cell death protein 1/programmed cell death protein ligand 1 (PD‑1/PD‑L1) related inhibitors, such as nivolumab and pembrolizumab, atezolizumab, avelumab and durvalumab have been shown to exhibit a high level of efficacy in several types of tumors. It has been confirmed that these inhibitors play an important role in the anti‑tumor process, significantly improving the survival rate of patients and delaying the progress of the underlying cancer. However, its method of therapeutic interference and potential for damaging the immune system has caused concern regarding its suitability. As these adverse effects are caused by an immune response to endogenous tissues, they are designated as immune‑related adverse events (irAEs). In this review, the typical irAEs reported in recent years and the management strategies adopted are highlighted, to serve as a reference in assessing the clinical response to these adverse reactions.

Research Progress and Existing Problems for Abscopal Effect

Radiation therapy plays a vital role in the treatment of tumours. In particular, the occurrence of the “abscopal effect” brings about a favourable turn for the treatment of patients with advanced metastatic malignant tumours. Because of the abscopal effect, non-irradiated areas are also treated. However, the abscopal effect occurs by chance, not through seeking. Although the abscopal effect has been studied enthusiastically, the desired result does not appear to be achieved. Moreover, its combination with immunotherapy appears to be overwhelming. There is an opinion that abscopal effect is difficult to achieve by irradiation of a single tumour, and irradiation of multiple or total lesions is advocated to increase the possibility of obtaining clinically meaningful outcomes. Obviously, there are still questions about the mechanism, condition and possibility underlying the occurrence of the abscopal effect. Can the abscopal effect truly change the future treatment strategy as the researchers expect? What are the current problems? This article reviewed the research in recent years to explore the progress and controversy surrounding the abscopal effect of radiation therapy.