Evidence map›Paper›PMID 33144335›Full record

ReviewJournal for immunotherapy of cancer2020

When steroids are not enough in immune-related hepatitis: current clinical challenges discussed on the basis of a case report.

Dimitrios C Ziogas, Aikaterini Gkoufa, Evangelos Cholongitas, Panagiotis Diamantopoulos, Amalia Anastasopoulou, Paolo Antonio Ascierto, Helen Gogas

Open access · goldAbstract readCase ReportsReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Journal for immunotherapy of cancer, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
28citing papers in PubMed, 4 pooled it
3.1field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

28 citing papers in PubMed, 4 syntheses or guidelines pooled it, 39 citations in OpenAlex.

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  10. Development of a Predictive Model for Classifying Immune Checkpoint Inhibitor-Induced Liver Injury Types.JGH open : an open access journal of gastroenterology and hepatology · 2025
    Article
  11. Immune-Mediated Liver Injury From Checkpoint Inhibitor: An Evolving Frontier With Emerging Challenges.Liver international : official journal of the International Association for the Study of the Liver · 2025
    Review
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors at 2 institutions in 2 countries.

Dimitrios C Ziogas *First Department of Medicine, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.
Aikaterini Gkoufa *First Department of Medicine, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.
Evangelos CholongitasFirst Department of Medicine, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.
Panagiotis DiamantopoulosFirst Department of Medicine, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.
Amalia AnastasopoulouFirst Department of Medicine, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.
Paolo Antonio AsciertoIstituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy.ORCID 0000-0002-8322-475X
Helen GogasFirst Department of Medicine, National and Kapodistrian University of Athens School of Medicine, Athens, Greece helgogas@gmail.com.
National and Kapodistrian University of Athens · GRIstituto Nazionale Tumori IRCCS "Fondazione G. Pascale" · IT

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Unleashing adaptive immunity via immune checkpoint inhibitors (ICPIs) in many cancer types led to durable antitumor responses and prolonged survivals and also added some new immune-related adverse events (irAEs) to the 'old-fashioned' safety profile of chemotherapy. Among bowel and endocrine irAEs, immune-mediated hepatotoxicity/hepatitis is a less common and far less well-studied toxicity, which, however, could develop into a serious complication, especially when it becomes persistent or refractory to steroids. Its incidence, onset and severity vary widely, depending on the type of underlying treated cancer, the class, the dosage and the duration of immunotherapy as well as the way of its administration (as a single agent or in combination with other ICPI or chemotherapy). In this study, we present a patient with metastatic melanoma who developed severe steroid-resistant ir-hepatitis after treatment with ipilimumab and required triple concurrent immunosuppression with prednisolone, mycofenolate mofetil and tacrolimus in order for his liver toxicity to be resolved. Intrigued by this case, we focused further on melanoma, as the disease-paradigm of immunotherapy in cancer, reviewed the reported incidence of hepatotoxicity among phase III ICPIs-containing trials on melanoma and discussed the main clinical considerations regarding the diagnosis and the management of persistent/steroid-refractory ir-hepatitis. As more clinical experience is gradually gained on this challenging topic, better answers are provided to questions about the appropriate diagnostic workup, the necessity of liver biopsy, the available immunosuppressive options beyond corticosteroids (their combinations and/or their sequence) as well as the correct decision on withdrawing or resuming immunotherapy. Nonetheless, a thorough multidisciplinary discussion is still required to individualize the overall approach in each case after failure of steroids.

Indexed as

AgedHepatitisHumansImmunotherapyMaleSteroidsSteroidsimmunotherapymelanomareview

Identifiers

PMID33144335
PMCPMC7607607
OpenAlexW3096009481

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.