Immunotherapy-associated liver toxicity in oncology: diagnosis, pathophysiology and therapeutic approach
Keywords:
Hepatitis inmunomediada; Inmunoterapia; Toxicidad hepática; Inhibidores de puntos de control inmunológico; Corticosteroides., Immune-mediated hepatitis; Immunotherapy; Hepatic toxicity; Immune checkpoint inhibitors; Corticosteroids.Abstract
Introduction: immune-mediated hepatitis constitutes a significant complication in oncologic patients treated with immune checkpoint inhibitors (ICIs). These therapeutic agents, designed to enhance the antitumor response through regulation of the immune system, may trigger an excessive immune reaction against hepatic tissue, disrupting immune tolerance and causing clinically relevant hepatotoxicity.
Objective: to analyze the incidence, pathophysiology, clinical manifestations, and management strategies of immune-mediated hepatitis associated with immunotherapy in oncology, based on updated scientific evidence.
Methods: a systematic literature review was conducted in PubMed, SciELO, and MEDLINE databases, selecting studies published between 2019–2024 that addressed the association between ICIs and hepatotoxicity. The PRISMA methodology was applied, including studies on incidence, pathophysiological mechanisms, diagnosis, and therapeutic strategies. A total of 847 initial records were identified, resulting in 23 high-quality articles for final analysis.
Results: the incidence of immune-mediated hepatitis ranges from 1–10 %, being higher in combined ICI therapy. Pathophysiology involves dysregulated activation of CD8+ T cells, reduction of regulatory T cells (Treg), hepatic lymphocytic infiltration, focal necrosis, and granuloma formation. Clinically, it presents with elevated transaminases (ALT and AST), potentially progressing to severe liver failure. CTLA-4 inhibitors show a higher incidence of hepatotoxicity compared to PD-1/PD-L1 inhibitors.
Conclusions: immune-mediated hepatitis represents a significant clinical challenge in contemporary oncology. Early diagnosis through systematic monitoring of liver function and timely therapeutic intervention are essential to prevent complications and ensure continuity of oncologic treatment.
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Copyright (c) 2026 Cristian Marcelo Castillo Paucar, Christian Alexis Ávila Díaz, Kevin René Lara Quinatoa, Heydi Nicole Paguay Pingos
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