Pembrolizumab-associated immune-related hepatitis: a retrospective case report analysis.

Objective: Analyzing the clinical characteristics, potential mechanisms, and treatment strategies of pembrolizumab-induced immune-related hepatitis to improve clinical management and treatment safety. Methods: Case reports on pembrolizumab-induced immune-related hepatitis were retrieved from databases including PubMed, Science Direct, and Web of Science. Forty-two case reports were carefully reviewed and data on patient age, gender, primary disease, time to hepatitis onset, clinical manifestations, liver injury indicators, adverse reaction grading, treatment strategies, and prognosis were collected and analyzed. Results: Among these patients, 27 were male and 14 were female, and the average age was 64.2 years. The clinical manifestations included liver toxicity, neurological symptoms, skin reactions, systemic symptoms, and digestive symptoms. The time from initiation of pembrolizumab to the onset of immune-related hepatitis varied significantly. The shortest duration is 2 days, while the longest is 630 days. Corticosteroids were the primary treatment. The pathogenesis may be related to the dysregulation of liver immune tolerance. Conclusion: Before initiating pembrolizumab, clinicians should thoroughly evaluate patients' liver function and history of liver disease, and consider the hepatotoxicity of concurrent medications. During the use of pembrolizumab, regular monitoring of liver function should be conducted. If any abnormalities are found, appropriate treatment should be given promptly. Meanwhile, further research is needed to better understand pembrolizumab-induced immune-related hepatitis.