RT Journal Article
SR Electronic
T1 Safety in treatment of hepatocellular carcinoma with immune checkpoint inhibitors as compared to melanoma and non-small cell lung cancer
JF Journal for ImmunoTherapy of Cancer
JO J Immunother Cancer
FD BMJ Publishing Group Ltd
SP 93
DO 10.1186/s40425-017-0298-2
VO 5
IS 1
A1 Zachary J. Brown
A1 Bernd Heinrich
A1 Seth M. Steinberg
A1 Su Jong Yu
A1 Tim F. Greten
YR 2017
UL http://jitc.bmj.com/content/5/1/93.abstract
AB Background Hepatocellular carcinoma (HCC) is a major health problem worldwide with increasing incidence rates. As HCC traditionally occurs in chronically inflamed livers, this inflammation aids to drive oncogenesis and often renders these lesions to be immunogenic and therefore potential targets for immunotherapy. As patients with HCC generally have underlying liver dysfunction, we sought to determine if immune checkpoint inhibitors were safe to use in patients with HCC as compared to melanoma and non-small cell lung cancer (NSCLC) in terms of the gastrointestinal side effects of elevation of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and diarrhea as well as patients who drop out of the study due to drug toxicity and death secondary to drug toxicity.Methods A literature review was performed for clinical trials that have been completed with single agent immune checkpoint inhibitors for patients with HCC, melanoma, and NSCLC. Gastrointestinal related adverse events including elevation of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and diarrhea were analyzed as well as those patients who were taken off therapy secondary to drug related toxicity and patients who died as a result of therapy.Results We found that although patients with HCC treated with immune checkpoint inhibitors have a substantial increase in AST/ALT as compared to patients with melanoma and NSCLC, this does not cause the patients to come off therapy or cause death secondary to drug toxicity.Conclusions We propose immune checkpoint inhibitors are safe to pursue in the treatment of HCC.Abbreviations:ALTAlanine AminotransferaseASTAspartate AminotransferaseCTLA-4Cytotoxic T-lymphocyte-associated protein-4ECOGEastern Cooperative Oncology GroupHBVHepatitis B virusHCCHepatocellular carcinomaHCVHepatitis C virusNRNot reportedNSCLCNon-small cell lung cancerPD-1Programmed cell death-1