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- Title
Immune Checkpoint Inhibitors in Hepatocellular Carcinoma and Their Hepatic-Related Side Effects: A Review.
- Authors
Ruli Jr., Thomas M.; Pollack, Ethan D.; Lodh, Atul; Evers III, Charles D.; Price, Christopher A.; Shoreibah, Mohamed
- Abstract
Simple Summary: Immunotherapy has evolved as a leading therapeutic modality for several malignancies, and increasing evidence has shown its utility in the treatment of hepatocellular carcinoma. Specifically, immune checkpoint inhibitors have shown promise as an alternative treatment for this neoplasm. However, given their ability to reactivate the immune system, these treatments pose significant risks, specifically hepatitis viral reactivation, autoimmune hepatitis, and hepatotoxicity. Here, we aim to review the potential hepatic side effects associated with immune checkpoint inhibitors in the treatment of hepatocellular carcinoma. In doing so, we hope to provide an effective summary detailing our current understanding of the true risk of developing these side effects for providers considering immune checkpoint inhibitor therapy for their patients with hepatocellular carcinoma. Primary liver cancer is one of the leading causes of cancer mortality worldwide, with hepatocellular carcinoma (HCC) being the most prevalent type of liver cancer. The prognosis of patients with advanced, unresectable HCC has historically been poor. However, with the emergence of immunotherapy, specifically immune checkpoint inhibitors (ICIs), there is reason for optimism. Nevertheless, ICIs do not come without risk, especially when administered in patients with HCC, given their potential underlying poor hepatic reserve. Given their novelty in the management of HCC, there are few studies to date specifically investigating ICI-related side effects on the liver in patients with underlying HCC. This review will serve as a guide for clinicians on ICIs' role in the management of HCC and their potential side effect profile. There will be a discussion on ICI-related hepatotoxicity, the potential for hepatitis B and C reactivation with ICI use, the potential for the development of autoimmune hepatitis with ICI use, and the risk of gastrointestinal bleeding with ICI use. As ICIs become more commonplace as a treatment option in patients with advanced HCC, it is imperative that clinicians not only understand the mechanism of action of such agents but also understand and are able to identify hepatic-related side effects.
- Subjects
RISK assessment; HEPATOTOXICOLOGY; GASTROINTESTINAL hemorrhage; LATENT infection; CHRONIC active hepatitis; IMMUNE checkpoint inhibitors; HEPATITIS B; LIVER; HEPATITIS C; HEPATOCELLULAR carcinoma; OVERALL survival; DISEASE risk factors
- Publication
Cancers, 2024, Vol 16, Issue 11, p2042
- ISSN
2072-6694
- Publication type
Article
- DOI
10.3390/cancers16112042