Editor's Note: Recently, the "8th International Forum on Drug-Induced Liver Injury and the 9th National Conference on Drug-Induced Liver Injury" along withthe release of the 2024 primary care version of  "Chinese Guidelines for the Diagnosis and Treatment of Drug-Induced Liver Injury" was held in the beautiful city of Xiamen. The theme of this conference focused on the management of liver injury caused by anti-tumor drugs, and it featured extensive academic exchanges by numerous renowned experts and scholars from home and abroad. We were honored to have Professor Guruprasad P. Aithal from the University of Nottingham share his insights on the clinical characteristics and treatment strategies for immune checkpoint inhibitor (ICI)-induced liver injury. This in-depth interview with Professor Aithal provides valuable guidance, helping us better understand and manage this potentially severe adverse reaction.

Clinical Characteristics, Risk Factors, and Monitoring of ICI-Induced Liver Injury:

Professor Aithal highlighted that in patients receiving ICI therapy, approximately one in every hundred patients per year may develop liver injury. Current research indicates that gender and combination therapy are two major risk factors. Women are about 2.5 times more likely to be affected by ICI-induced liver injury than men. Additionally, using a combination of two ICIs, such as CTLA-4 inhibitors with PD-1 or PD-L1 inhibitors, also increases the risk of liver injury. While these risk factors are difficult to completely avoid, raising awareness among patients and physicians, especially in high-risk groups, can help better manage and prevent liver injury.

Given the potential severity of ICI-induced liver injury, patients typically need liver function tests during treatment. This is particularly crucial in the first six months of treatment when adverse reactions are most likely to occur. However, even after six months, if patients exhibit symptoms, they should be promptly tested.

Pathological Characteristics and Mechanisms of ICI-Induced Liver Injury:

In susceptible individuals, Professor Aithal’s research has identified a unique type of T cell that can be recognized using a simple flow cytometry test. They are currently conducting further research to clarify its mechanism of action and provide guidance for clinical practice.

Treatment Strategies for ICI-Induced Liver Injury:

For ICI-induced liver injury, Professor Aithal believes the current treatment strategies are overly aggressive, often involving premature use of high-dose corticosteroids to suppress the immune system. He suggests that in cases where the condition is not severe, more time should be given for monitoring, with treatment introduced only if the condition worsens. He also emphasizes the importance of controlling treatment dosages, recommending the use of standard doses for treatment.

Research Outlook on ICI-Induced Liver Injury:

Looking ahead, Professor Aithal suggests conducting whole-genome association studies to identify patients who are more likely to develop ICI-induced liver injury. This would aid in more accurate diagnosis and the use of more specific biomarkers for personalized treatment. He underscores the importance of early identification and personalized treatment to improve clinical practice.