The clinical course of immune checkpoint inhibitor-induced cholangitis cases
| Cases | Imaging | Treatment | Timepoint | Liver function tests | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| US | MRCP | UDCA | Cortico-steroids | MMF | TAC | IFX | NAC | Bil** | ALP | GGT | AST | ALT | ||
| Case 1 | 750 mg | 4 mg/kg IVMP | 1.5 g BD | 3 mg BD | 5 mg/kg | * | Pre-ICI | 5 | 85 | 24 | 20 | 10 | ||
| Day 0 | 20 | 981 | 998 | 420 | 389 | |||||||||
| MRCP | 21 | 601 | 862 | 124 | 176 | |||||||||
| Peak | 141 | 1142 | 1672 | 272 | 352 | |||||||||
| Day 482(most recent) | 30 | 524 | 1078 | 76 | 80 | |||||||||
| Case 2 | - | 500 mg IVMP | 1 g BD | 3 mg BD | - | * | Pre-ICI | 12 | 155 | 192 | 51 | N/A | ||
| Day 0 | 5 | 301 | 474 | 44 | 117 | |||||||||
| MRCP | 76 | 808 | 2249 | 454 | 1197 | |||||||||
| Peak (and most recent) | 453 | 1165 | 2785 | 219 | 547 | |||||||||
| Case 3 | - | 4 mg/kg IVMP | 1.25 g BD | 3 mg BD | 5 mg/kg | - | Pre-ICI | 7 | 147 | 166 | 38 | 50 | ||
| Day 0 | 17 | 1088 | 2952 | 130 | 183 | |||||||||
| MRCP | 37 | 1084 | 3278 | 146 | 247 | |||||||||
| Peak | 65 | 1404 | 4994 | 262 | 278 | |||||||||
| Day 482(most recent) | 33 | 974 | 2559 | 40 | 75 | |||||||||
Green indicates performed/received, and red indicates not performed/received. The highest doses received for each treatment are specified. Day 0 refers to the day of immune checkpoint inhibitor-induced hepatotoxicity diagnosis, liver function tests are provided for the day of MRCP. Peak values were selected based on the day of the patient’s highest measured bilirubin value. ICI-H: immune checkpoint inhibitor-induced hepatotoxicity; US: ultrasound; MRCP: magnetic resonance cholangiopancreatography; UDCA: ursodeoxycholic acid; mg/kg: milligrams per kilograms of bodyweight; IVMP: intravenous methylprednisolone; MMF: mycophenolate mofetil; BD: twice-daily; TAC: tacrolimus; IFX: infliximab; NAC: N-acetylcysteine; Bil: bilirubin; ALP: alkaline phosphatase; GGT: γ-glutamyltransferase; AST: aspartate aminotransferase; ALT: alanine aminotransferase. *: see [9]; **: μmol/L. All other liver function tests in units per litre