Scholarlink

A patient with a pre-existing medical diagnosis of obesity and diabetes who was treated with combination ICI therapy with ipilimumab and nivolumab, in addition to cabozantinib, then developed severe IMCH. The patient was started on ursodiol initially and then oral budesonide (accounting for diabetes history). Because budesonide was deemed inadequate to induce remission, IV steroids were promptly initiated at the expense of anticipated hyperglycemia as an adverse effect, but with the intention to bridge the patient directly to IV tocilizumab. Tocilizumab acted as a steroid-sparing strategy to decouple the treatment from steroids while still attaining biochemical remission. This attenuated the patient’s hyperglycemia issues by allowing for a rapid steroid taper over only 3 weeks. His liver enzymes achieved biochemical remission, and the patient was restarted on nivolumab and then cabozantinib. After additional nivolumab cycles in remission from IMCH, he developed recurrence of ICI-related cholangiohepatitis. Tocilizumab was used again without concurrent use of steroids. A significant, but transient elevation of liver enzymes was seen due to a suspected tocilizumab drug-induced liver injury. The patient did not develop acute liver failure. Through observation only, his liver enzymes eventually returned to baseline, and the patient successfully attained biochemical remission again.

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Hepatobiliary Toxicity Secondary to Immune Checkpoint Inhibitor Therapy: Early Tocilizumab Treatment to Decouple Steroid Dependency

  • 章节

  • 发表日期：

    2025年

查看全文
  • Hao Chi Zhang,
  • Sean Ngo,
  • Deyali Chatterjee,
  • Ethan Miller,
  • Amado J. Zurita,
  • Lan Wang

摘要

A patient with a pre-existing medical diagnosis of obesity and diabetes who was treated with combination ICI therapy with ipilimumab and nivolumab, in addition to cabozantinib, then developed severe IMCH. The patient was started on ursodiol initially and then oral budesonide (accounting for diabetes history). Because budesonide was deemed inadequate to induce remission, IV steroids were promptly initiated at the expense of anticipated hyperglycemia as an adverse effect, but with the intention to bridge the patient directly to IV tocilizumab. Tocilizumab acted as a steroid-sparing strategy to decouple the treatment from steroids while still attaining biochemical remission. This attenuated the patient’s hyperglycemia issues by allowing for a rapid steroid taper over only 3 weeks. His liver enzymes achieved biochemical remission, and the patient was restarted on nivolumab and then cabozantinib. After additional nivolumab cycles in remission from IMCH, he developed recurrence of ICI-related cholangiohepatitis. Tocilizumab was used again without concurrent use of steroids. A significant, but transient elevation of liver enzymes was seen due to a suspected tocilizumab drug-induced liver injury. The patient did not develop acute liver failure. Through observation only, his liver enzymes eventually returned to baseline, and the patient successfully attained biochemical remission again.