2024 World Conference on Lung Cancer (WCLC) - ePosters-EP.11E.05 Outpatient Treatment Strategies for Grade 3-4 Immune-Mediated Hepatitis in Patients with Lung Cancer

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The document discusses strategies for managing grade 3-4 immune-mediated hepatitis in lung cancer patients receiving immune checkpoint inhibitors. With the rise of these inhibitors in oncology, immune-mediated hepatitis has become a common adverse event, affecting 5-15% of patients. Traditionally, hospitalization and corticosteroids (1-2 mg/kg/day) are recommended as the initial treatment. However, corticosteroid pulse therapy, effective in other conditions like lupus nephritis, could offer reduced toxicity and similar efficacy.<br /><br />The report presents three cases of patients with advanced lung cancer who developed grade 3-4 hepatitis during treatment with immune checkpoint inhibitors. These patients were treated with outpatient corticosteroid pulse therapy. <br /><br />1. Patient A, a 60-year-old woman with stage IV small-cell lung cancer (SCLC), developed asymptomatic grade 3 hepatitis after 10 cycles of maintenance Atezolizumab following initial treatment.<br />   <br />2. Patient B, a 62-year-old woman also with stage IV SCLC, developed grade 4 hepatitis after 36 cycles of maintenance Atezolizumab following a complete response to initial treatment.<br /><br />3. Patient C, a 62-year-old man with stage IVB lung adenocarcinoma, showed a partial response to initial treatment and developed grade 3 hepatitis after 16 months of maintenance therapy. His liver function normalized after suspension of Mycophenolate Mofetil (MMF), indicating its efficacy as an adjunct treatment.<br /><br />The conclusion emphasizes the potential of corticosteroid pulse therapy to avoid hospitalization and reduce toxicity while being effective for managing grade 3-4 toxicities, especially in patients who are refractory to standard therapies. MMF is noted as a beneficial adjunct for steroid-refractory cases. Further studies are needed to determine the best dosing and duration for these treatments.

Asset Subtitle

Ana Cardeña-Gutiérrez

Meta Tag

Speaker Ana Cardeña-Gutiérrez

Topic Metastatic Non-small Cell Lung Cancer – Immunotherapy

Keywords

immune-mediated hepatitis

lung cancer

immune checkpoint inhibitors

corticosteroid pulse therapy

grade 3-4 toxicities

hospitalization

Mycophenolate Mofetil

advanced lung cancer

oncology

treatment strategies