Successful Treatment with Short-Term Steroid Against Severe Hepatitis Confirmed by Liver Biopsy in a Patient with Advanced Squamous-Cell Lung Cancer Receiving a Combination of Pembrolizumab, Carboplatin, and Nab-Paclitaxel: A Case Report

Abstract

Pembrolizumab is an immune checkpoint inhibitor (ICI) that targets programmed death-1. Although ICIs have shown efficacy in the treatment of lung cancer, they have also been reported to cause a variety of immune-related adverse events (irAEs). Hepatotoxicity is a known irAEs, but currently, there is not enough information on its pathological characteristics and treatment. We report the case of a 70-year-old man with advanced squamous-cell lung cancer who developed severe grade 4 hepatitis on day 8 after receiving carboplatin, nab-paclitaxel, and pembrolizumab as fourth-line therapy. We treated him with steroid therapy the day after a liver biopsy was performed to investigate his pathological features, which led to a rapid and remarkable improvement. Confirmation of immune-related hepatotoxicity by pathological findings allowed the early tapering and discontinuation of steroid therapy. Performing a liver biopsy and verifying histological characteristics are needed for successful treatment with short-term steroids when drug-induced hepatitis caused by anti-cancer therapy including pembrolizumab is considered.

Cryobiopsy for pneumonitis diagnosis in NSCLC immunotherapy

“…Non-small cell lung cancer is still diagnosed at advanced stage and systemic treatment administration is required. We have nowadays novel tools for the diagnosis and staging of lung cancer like radial-ebus, electromagnetic navigation and convex probe-ebus [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] ]. However; we still need a successful lung cancer screening program for early lung cancer diagnosis [ 9 ].…”

“…Immunotherapy is considered nowadays the tip of the arrow for non-small cell lung cancer and it can be administered alone when the programmed death-ligand 1 (PD-L1) is ≥ 50% or in combination with chemotherapy when the PD-L1 expression is ≤ 50%. This type of therapy is considered to have mild adverse effects like fatigue, cough, nausea, itching, skin rash, loss of appetite, constipation, joint pain, diarrhea and it care trigger thyroiditis, hepatitis and induce pneumonitis [ [16] , [17] , [18] ]. These adverse effects can be addressed with different measures based on their severity.…”