Severe hepatitis arising from ipilimumab administration, following melanoma treatment with nivolumab

• Published in: Japanese journal of clinical oncology Vol. 47; no. 2; pp. 175 - 178
• Main Authors: Tanaka, Ryota, Fujisawa, Yasuhiro, Sae, Inoue, Maruyama, Hiroshi, Ito, Shusaku, Hasegawa, Naoyuki, Sekine, Ikuo, Fujimoto, Manabu
• Format: Journal Article
• Language: English
• Published: England 11.02.2017
• Subjects: Antibodies, Monoclonal - adverse effects; Antibodies, Monoclonal - therapeutic use; Chemical and Drug Induced Liver Injury - drug therapy; Chemical and Drug Induced Liver Injury - etiology; Humans; Ipilimumab - adverse effects; Ipilimumab - therapeutic use; Male; Melanoma - drug therapy; Melanoma - virology; Middle Aged; Mycophenolic Acid - therapeutic use; melanoma; mycophenolate mofetil; nivolumab; hepatitis; ipilimumab
• ISSN: 0368-2811; 1465-3621
• DOI: 10.1093/jjco/hyw167

After 4 weeks of the last dose of nivolumab, a 59-year-old man with stage IV melanoma was subject to treatment with ipilimumab. After 5 weeks, the patient developed severe hepatitis, showing markedly elevated levels of both aspartate aminotransferase and alanine aminotransferase (>2000 U/l). Using pulse steroid therapy with 1000 mg/d of methylprednisolone, liver function initially improved, but then deteriorated upon dosage reduction. Subsequently, mycophenolate mofetil (MMF) was administered at a dose of 2 g/d in addition to the corticosteroid, which resulted in aspartate aminotransferase and alanine aminotransferase levels gradually improving to grade 1, and the corticosteroid dose was successfully reduced to 0.5 mg/kg/d of oral prednisolone. Liver function then remained stable when MMF was tapered. In conclusion, the use of MMF improved liver function in this patient with steroid-refractory hepatitis induced by immune checkpoint inhibitor administration.