Hepatotoxicity of Chemotherapy and Immune Checkpoint Inhibitors

Abstract

Hepatotoxicity from oncologic drugs represents an increasing clinical burden for patients, providers, and the health care system. The complexity of clinical presentations, multi-drug regimens, and the need to control the underlying cancer while preserving liver function, results in significant diagnostic and therapeutic challenges. These challenges are best met with a careful and systematic approach with multi-disciplinary management decisions between oncology and hepatology providers. This contemporary review discusses the known pathophysiology and patterns of hepatotoxicity for key drug classes and agents, including unique presentations such as sinusoidal obstruction syndrome, key aspects of the diagnostic approach, and principles of management.

Keywords: Chemotherapy; Drug-induced liver injury; Hepatotoxicity; Immune checkpoint inhibitor; Immune checkpoint inhibitor-mediated hepatitis; Sinusoidal obstructive syndrome.