Cancer immunotherapy, particularly immune checkpoint inhibitors, has positively impacted oncological treatments. Despite its effectiveness, immunotherapy is associated with immune-related adverse events (irAEs) that can affect any organ, including the liver. Hepatotoxicity primarily manifests as immune-related hepatitis and, less frequently, cholangitis. Several risk factors, such as pre-existing autoimmune and liver diseases, the type of immunotherapy, and combination regimens, play a role in immune-related hepatotoxicity (irH), although reliable predictive markers or models are still lacking. The severity of irH ranges from mild to severe cases, up to, in rare instances, acute liver failure. Management strategies require regular monitoring for early diagnosis and interventions, encompassing strict monitoring for mild cases to the permanent suspension of immunotherapy for severe forms. Corticosteroids are the backbone of treatment in moderate and high-grade damage, alone or in combination with additional immunosuppressive drugs for resistant or refractory cases. Given the relatively low number of events and the lack of dedicated prospective studies, much uncertainty remains about the optimal management of irH, especially in the most severe cases. This review presents the main features of irH, focusing on injury patterns and mechanisms, and provides an overview of the management landscape, from standard care to the latest evidence.
癌症免疫疗法，特别是免疫检查点抑制剂，已对肿瘤治疗产生积极影响。尽管疗效显著，免疫疗法也可能引发累及包括肝脏在内的任何器官的免疫相关不良事件。肝毒性主要表现为免疫相关性肝炎，少数情况下表现为胆管炎。虽然目前仍缺乏可靠的预测标志物或模型，但既有自身免疫性疾病和肝脏疾病、免疫疗法类型及联合用药方案等多种风险因素在免疫相关性肝损伤的发生中起重要作用。该损伤的严重程度从轻度到重度不等，极少数情况下可进展为急性肝衰竭。管理策略需通过定期监测实现早期诊断与干预，涵盖从轻度病例的严格监测到重度病例永久停用免疫疗法的多层次措施。中重度肝损伤以皮质类固醇为基础治疗方案，对于耐药或难治性病例可联合其他免疫抑制剂。由于相关事件数量相对有限且缺乏专门的前瞻性研究，目前对免疫相关性肝损伤的最佳管理方案，尤其是最严重病例的处理，仍存在诸多不确定性。本综述系统阐述免疫相关性肝损伤的核心特征，重点分析其损伤模式与发生机制，并从标准诊疗到最新循证依据，全面梳理该领域的管理现状。
Hepatotoxicity in Cancer Immunotherapy: Diagnosis, Management, and Future Perspectives
肿瘤(癌症)患者之家