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Cited by 293

The DOI matches its Crossref record; 13 of the 13 references it cites were found in a registry or an index.

Diagnosis and management of toxicities of immune checkpoint inhibitors in hepatocellular carcinoma

Open access
Sangro, Bruno, Chan, Stephen L., Meyer, Tim, Reig, María, El-Khoueiry, Anthony, Galle, Peter R.·2020·Journal of Hepatology
DOI 10.1016/j.jhep.2019.10.021
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Abstract

Summary Immune checkpoint inhibitors (ICIs) have reshaped cancer therapy. ICIs enhance T cell activation through various mechanisms and may help reverse the exhausted phenotype of tumour-infiltrating lymphocytes. However, disrupting the key role that checkpoint molecules play in immune homeostasis may result in autoimmune complications. A broad range of immune-related adverse events (irAEs) involve almost every organ but mostly affect the skin, digestive system, lung, endocrine glands, nervous system, kidney, blood cells, and musculoskeletal system. They are usually manageable but can be life-threatening. The incidence of irAEs is not very different in patients with hepatocellular carcinoma (HCC) compared to other tumour types, although there is a trend towards a higher incidence of hepatic irAEs. HCC usually develops on a background of cirrhosis with associated systemic manifestations. Extrahepatic organ dysfunction in cirrhosis may cause signs and symptoms that overlap with irAEs or increase their severity. Available guidelines for the management of irAEs have not specifically considered the assessment of toxicities in the context of patients with liver cancer and cirrhosis. This review addresses the toxicity profile of ICIs in patients with HCC, focusing on the challenges that the underlying liver disease poses to their diagnosis and management. Challenges include late recognition, inadequate work-up and delayed treatment, overdiagnosis and inappropriate interruption of ICIs, complications caused by immunosuppressive therapy, and increased cost. A specific algorithm for the management of hepatic irAEs is provided.

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Metadata

Authors
Sangro, B., Chan, S. L., Meyer, T., Reig, M., El-Khoueiry, A., & Galle, P. R.
Venue
Journal of Hepatology
Publisher
Elsevier BV
Published
2020-02
Volume
72
Issue
2
Pages
320-341
ISSN
0168-8278 (ISSN-L)
DOI
10.1016/j.jhep.2019.10.021
OpenAlex
W2998900184
Cited by
293
References
13
FWCI
15.88
Type
journal article
Language
en
Open access
green

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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

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