Overview
In this multi-center prospective observational study, the investigators plan to identify the incidence and risk factors for checkpoint inhibitor-induced liver injury and characterize biochemical, genetic, immunological, and histological features associated with it.
Description
Checkpoint inhibitor-induced liver injury (ChILI) is a new incompletely understood category of hepatotoxicity which is distinct from other types of drug-induced liver injury (DILI) such as direct or idiosyncratic DILI. The data regarding the incidence and risk factors is lacking. Therefore, 'in-depth phenotyping' together with data from the control group exposed to checkpoint inhibitors (CPI) is necessary to develop refined algorithms incorporating CPI-related factors, host genetic and environmental risk factors that would enable pre-empting ChILI.
The aim of the study is to enroll two deeply phenotyped cohorts (patients who developed ChILI and patients who are starting checkpoint inhibitors) and obtain biological samples at multiple time points.
Eligibility
Inclusion Criteria:
Both patient groups and control group:
• Able to give written informed consent OR Potential participants who have developed
encephalopathy related to ChILI as a response to checkpoint inhibitor therapy, who lack the
capacity to give written informed consent and have a consultee (personal or nominated) -
for ChILI patient group only
ChILI group:
Patients who developed checkpoint inhibitor-induced liver injury and meet the following
criteria:
1. Meets one of the following analytical thresholds at enrolment (visit 1)
- Alanine transaminase (ALT) exceeding 5 times the upper limit of normal (ULN) OR
- ALT exceeding 3 times ULN plus bilirubin exceeding 2 times ULN OR
- Alkaline phosphatase (ALP) exceeding 2 times ULN with accompanying elevations of
gamma-glutamyl transferase in the absence of known bone metastases driving the
rise in ALP level
2. Absence of other known causes of liver injury after detailed investigations
Patients who developed ChILI but did not meet the above criteria at enrolment or who were
found to have a different cause for their liver injury after further investigations will be
excluded from the analysis
Control group:
Consecutive patients with cancer who have a clinical indication to start checkpoint
inhibitors. A small proportion of patients will develop ChILI following their checkpoint
inhibitor treatment and will be classified as cases.
Exclusion Criteria:
- Patients who are treated with cytotoxic chemotherapy concurrently with checkpoint
inhibitors.
- On the judgment of chief investigator that the person has certain alternative
explanations to the acute event (rather than ChILI).