The American Society of Clinical Oncology (ASCO) has reviewed complications associated with immune checkpoint inhibitor therapy. One complication is hepatitis.
Patient selection: pneumonitis following therapy with immune checkpoint inhibitor
Parameters:
(1) serum AST in U/L as a multiple of ULN
(2) serum ALT in U/L as a multiple of ULN
(3) serum total bilirubin in mg/dL as a multiple of ULN
(4) clinical liver dysfunction
(5) hepatic fibrosis
(6) cirrhosis
(7) reactivation of chronic hepatitis
Parameter
Finding
Grade
AST and/or ALT
<= ULN
0
> ULN to 3.0 times ULN
1
3.01 to 5 times ULN
2
5.01 to 20 times ULN
3
> 20 times ULN
4
serum total bilirubin
<= ULN
0
> ULN to 1.5 times ULN
1
1.51 to 3.0 times ULN
2
3.01 to 10 times ULN
3
> 10 times ULN
4
clinical liver dysfunction
asymptomatic
0
symptomatic
3
decompensated
4
fibrosis by biopsy
no
0
yes
3
cirrhosis
no
0
compensated
3
decompensated
4
reactivation of chronic hepatitis
no
0
yes
3
where:
• Decompensated liver dysfunction: ascites, coagulopathy, encephalopathy, coma
grade of hepatitis =
= MAX(grades for all of the parameters)
Differential diagnosis:
(1) drug toxicity
(2) infectious hepatitis
(3) other forms of immune hepatitis
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