Liver failure resolved via corticosteroids plus plasma exchange in a patient with hepatocellular carcinoma receiving nivolumab immunotherapy: case report

Background: Therapy with immune checkpoint inhibitors (ICIs) is an option for advanced hepatocellular carcinoma (HCC). Prednisone is recommended for immune-mediated hepatotoxicity (IMH) induced by ICIs in guidelines. However, liver failure is a severe and fetal IMH of ICIs, and little is known about the combined therapy of corticosteroids and plasma exchange (PE) for this IMH. Case Description: Herein, we present a case of liver failure induced by the anti-PD-1 antibody nivolumab in a patient with advanced hepatitis B virus infection (HBV)-related HCC. This patient developed fulminate liver failure 2 weeks later after the nivolumab treatment besides receiving twice transcatheter arterial chemoembolization (TACE) therapy. Cell immunity in peripheral blood and serum inflammatory cytokine levels were evaluated by flowcytometry and enzyme linked immunosorbent assay. The combined treatment of corticosteroid and PE at the early stage of liver failure in this patient successfully led to a rapid recovery. Elevated levels of interleukin (IL)-10 and tumor necrosis factor α (TNF-α) in serum, a lower proportion of CD8+ T cells and an increased CD4+/CD8+ ratio were also found. Conclusions: Our case report suggested that corticosteroid combined with PE might be a feasible treatment option for nivolumab induced liver failure in HBV-related HCC, and early detection and prevention of liver failure were also necessary during ICIs therapy.