Acute liver failure following immune checkpoint inhibitors

We report the case of a 64-year-old man admitted to intensive care unit for liver failure secondary to immune-mediated hepatitis. This patient suffered from a progressing laryngeal squamous cell carcinoma. A treatment was started with immune checkpoint inhibitors combining anti PD-L1 plus novel anti-TIGIT or placebo (ATEZOLIZUMAB plus TIRAGOLUMAB or placebo), as part of a clinical trial. The patient then developed immune-mediated hepatitis, proven by liver biopsy. Despite 14 days of corticosteroids at 2 mg/kg the condition of the patient worsened, with the development of liver failure. The patient was admitted to intensive care unit, treated with plasma exchange, and made a complete recovery from this life-threatening condition. To our knowledge this is the case of a successful use of plasma exchange to treat ATEZOLIZUMAB +/- TIRAGOLUMAB induced liver toxicity. Plasma exchange could be a potential lifesaving treatment to severe immune-mediated hepatitis.