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Misleading impaired liver function in a non-small-cell lung cancer patient treated with pembrolizumab

a case report

Osman, Giorgia A.a; Marra, Arnaldod; Iacono, Danielaa; Giannelli, Valeriob; Ricciardi, Serenaa; Remotti, Danielec; Vecchione, Andreae; Ricci, Albertof; Palange, Paolod; Migliorino, Maria R.a

doi: 10.1097/CAD.0000000000000764
Case Reports

In the last few years, immunotherapy has become part of everyday clinical practice for the treatment of many solid tumors including metastatic non-small-cell lung cancer. These drugs, however, can yield a specific toxicity profile that consists of immune-related adverse events (irAEs). Hepatotoxicity is one of irAEs and occurs in about 1–3% of cases and may be manifested by the presence of increate levels of liver enzymes (aspartate aminotransferase, alanine aminotransferase) and/or biliary stasis evidence; in these cases, a differential diagnosis with other hepatic diseases must be considered. We present the case of a 73-year-old man who presented with an alteration in liver function during treatment with pembrolizumab (anti-programmed death 1 monoclonal antibody) for a stage IV nonsquamous non-small-cell lung cancer, which was initially mistaken for drug-induced irAEs hepatic toxicity.

aPulmonary Oncology Unit

bDivision of Hepatology

cPathology Department, San Camillo Forlanini Hospital

dDepartment of Public Health and Infectious Diseases

eDepartment of Clinical and Molecular Medicine, Division of Pathology

fDepartment of Clinical and Molecular Medicine, Division of Pneumology, Sapienza University of Rome, Sant’Andrea Hospital, Rome, Italy

Received 11 November 2018 Revised form accepted 24 January 2019

Correspondence to Giorgia A. Osman, MD, Pulmonary Oncology Unit, San Camillo Forlanini Hospital Circonvallazione Gianicolense 87, 00152 Rome, Italy Tel: +39 065 870 4557; fax:+39 065 870 6098; e-mail:

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