In the journey of cancer treatment, drug-induced liver injury is a significant issue that cannot be overlooked. The "8th International Forum on Drug-Induced Liver Injury," held on May 25, 2024, focused on the management of drug-induced liver injury caused by anticancer drugs, inviting numerous renowned experts and scholars from around the world for rich academic exchanges. During the forum, we had the honor of interviewing Professor Victor Navarro from the Department of Hepatology at the Einstein Medical Network in Philadelphia, Pennsylvania, USA. He shared his unique insights on the management of drug-induced liver injury in oncology.

Application and Challenges of Drug-Induced Liver Injury Networks

Professor Navarro emphasized the importance of drug-induced liver injury networks in monitoring and understanding liver injuries caused by anticancer drugs. He pointed out that, although anticancer drugs are not the primary cause of drug-induced liver injury in the United States, their impact is becoming increasingly significant, especially immune checkpoint inhibitors (ICIs). The drug-induced liver injury network, through the collection and analysis of patient data, has deeply researched the types, severity, and risk factors of liver injuries caused by these drugs. It has been found that ICI-induced liver injury has become increasingly common, which is related to the increasing number of ICIs approved and used in the United States.

However, Professor Navarro also candidly acknowledged that the main challenge currently faced is how to include these patients in studies. Since most patients are treated according to relevant cancer treatment guidelines, it is difficult to include them in studies on drug-induced liver injury networks.

Experience and Successful Cases in Managing Drug-Induced Liver Injury in Oncology

When discussing his experience in managing drug-induced liver injury in oncology, Professor Navarro shared his experience in managing patients treated with ipilimumab. With the rise of combination immunotherapy, they began to observe more severe immune-related events. However, he noted that although ICIs can lead to severe immune-related reactions, this may be related to better treatment outcomes for cancer patients, as a strong immune response may help control the tumor. Taking a melanoma patient as an example, the patient received combination immunotherapy and developed grade 3 liver injury. After about four months of ICI treatment and subsequent high-dose corticosteroid treatment for two to three months, the patient’s liver function improved, and corticosteroid treatment has been discontinued. At a 9-month follow-up, the tumor has not recurred.

Individual Differences in Liver Injury and Strategies for Coping

Professor Navarro pointed out that drug-induced liver injury in oncology may vary due to differences in drug types, individual differences in patients, or different stages of treatment. They found through their research that female patients, those receiving CTLA-4 inhibitors, and especially those receiving PD-1 inhibitors in combination therapy, are more prone to immune-related adverse reactions. These adverse reactions are more common in certain tumors, such as melanoma and renal cell carcinoma. Therefore, it is crucial to develop strategies for different situations.

Potential of New Technologies and Approaches

Regarding the prevention and management of drug-induced liver injury in oncology, Professor Navarro believes that there is still much to learn. Although they have some understanding of the risk factors related to liver injury, accurately predicting related liver injuries in cancer patients is still in its early stages. He emphasized that future research needs to focus on biomarkers and potential genetic susceptibility to help identify which patients may be at additional risk of liver injury and to develop relevant prevention strategies. In addition, research needs to explore whether other drugs can be added to ICI therapy to prevent toxicity.

Recommendations and Outlook

Finally, Professor Navarro offered some good advice to clinical physicians, researchers, and the public. He emphasized the need for caution when using steroids to treat immune-related liver diseases. Although guidelines recommend the use of steroids, the data do not fully support their benefits. Therefore, it is appropriate to gradually reduce the use of steroids if patients do not improve within a reasonable period. He also reminded that most ICI-related liver injuries occur 3-6 months after the start of treatment. If liver injury occurs before or after this time, other causes should be sought. Looking to the future, Professor Navarro hopes that with more research and technological advances, we can better understand and address the challenges of drug-induced liver injury in oncology.