[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-384970-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-384970-en":131},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","delayed-immune-mediated-hepatitis-after-three-cycles-of-pembrolizumab-for-the-treatment-of-sinonasal-melanoma","Delayed immune-mediated hepatitis after three cycles of pembrolizumab for the treatment of sinonasal melanoma","","Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that activate anti-tumor T-cell responses by targeting co-inhibitory immune checkpoints such as PD-1 and CTLA-4. Clinical use has improved outcomes, but immune-related adverse events (IRAEs) commonly arise 4–12 weeks after starting therapy and typically within 3 months after the last dose. This report describes a delayed case of immune-mediated hepatitis occurring 3 months after the final pembrolizumab dose, supported by liver histopathologic findings, emphasizing the need for continued surveillance after treatment cessation.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/delayed-immune-mediated-hepatitis-after-three-cycles-of-pembrolizumab-for-the-treatment-of-sinonasal-melanoma/384970/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/delayed-immune-mediated-hepatitis-after-three-cycles-of-pembrolizumab-for-the-treatment-of-sinonasal-melanoma/384970.png","ImageObject",300,407,{"name":42,"@type":43},"Angel","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-05","2026-09-24",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",13,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What is pembrolizumab and why can it cause immune-related adverse events?","Question",{"text":63,"@type":64},"Pembrolizumab is a monoclonal antibody targeting PD-1, part of immune checkpoint inhibition. By upregulating immunity, it can trigger immune-related adverse events such as immune-mediated hepatitis.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"When did the delayed immune-mediated hepatitis occur in this case?",{"text":68,"@type":64},"Delayed immune-mediated hepatitis developed 3 months after cessation of pembrolizumab, with severe liver injury detected at 158 days after initiation and 105 days after the last administration.",{"name":70,"@type":61,"acceptedAnswer":71},"How was other liver injury causes evaluated before biopsy?",{"text":72,"@type":64},"The case report notes negative viral and autoimmune-related markers, normal coagulation markers, and an abdominal CT scan without structural liver or biliary abnormalities, leading to a liver biopsy for differential diagnosis.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},384970,1790534931,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,127],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":124,"doc_module":4,"doc_module_name":25,"category_name":125,"show_sort_weight":124,"slug":126},10,"Lifestyle","lifestyle",{"id":128,"doc_module":4,"doc_module_name":25,"category_name":129,"show_sort_weight":97,"slug":130},19,"General","general",{"code":4,"msg":82,"data":132},{"doc_id":79,"user_id":133,"nickname":42,"user_avatar":134,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":97,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":55},687207412472,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","ADR Report   \nDelayed immune-mediated hepatitis after three cycles of pembrolizumab for the treatment of sinonasal melanoma  \nKang S1, Lee HJ2, Lee HJ1  \n1 Division of Hematology and Oncology, Department of Internal Medicine, 2 Department of Pathology, Chungnam National University Hospital and College of Medicine, Daejeon, Republic of Korea  \nAddress for correspondence: Dr. Lee HJ,  \nE-mail: [cymed@cnu.ac.kr](cymed@cnu.ac.kr)  \n[Received : 20](Received : 20)‑10‑2022  \nReview completed : 06‑01‑2023  \nAccepted : 27‑01‑2023  \nPublished : 27‑06‑2023  \nABSTRACT   \nImmune checkpoint inhibitors (ICIs) are monoclonal antibodies that induce the anti‑tumor effects of T cells by targeting co‑inhibitory immune checkpoints. The development of ICIs has revolutionized the clinical practice of oncology, leading to significant improvements in outcomes; therefore, ICIs are now standard care for various types of solid cancers. Immune‑related adverse events, the unique toxicity profiles of ICIs, usually develop 4–12 weeks after initiation of ICI treatment; however, some cases can occur >3 months after cessation of ICI treatment. To date, there have been limited reports about delayed immune‑mediated hepatitis (IMH) and histopathologic findings. Herein, we present a case of delayed IMH that occurred 3 months after the last dose of pembrolizumab, including histopathologic findings of the liver. This case suggests that ongoing surveillance for immune‑related adverse events is required, even after cessation of ICI treatment.  \nKEY WORDS: Delayed immune adverse events, hepatitis, melanoma, pembrolizumab  \nIntroduction  \nImmuneantibodicheseckpthatoinininhuceiithoersanIiC-tIsum) aorreemonffecscloonfalT cells by targeting co-inhibitory immune checkpoints, such as programmed cell death protein 1 (PD-1) or cytotoxic T-lymphocyte antigen-4 (CTLA-4) . [1] Immunotherapy with ICIs have significantly improved the outcomes of patients with solid tumors; thus, their use in (neo) adjuvant and metastatic settings of cancers has dramatically increased. Pembrolizumab, first approved in 2014, is a monoclonal antibody targeting PD-1. Nowadays, it is one of the most widely used ICIs for patients with various types of solid cancers, including non-small-cell lung cancer and malignant melanoma.  \nHowever, due to the unique mechanism of ICIs, which induce upregulation of immunity, unique adverse events, so-called immune-related adverse events (IRAEs), are key challenges for physicians. [1] In general, the median time to onset of IRAEs from the commencement of ICI treatment is known to be 8–12 weeks, and most cases occur during immunotherapy or \u003C3 months from the last dose. [2]  \nHowever, a few cases occur >3 months after the last administration of immunotherapy. [3,4] In the literature, few cases of delayed immune-mediated hepatitis (IMH) and their histologic findings have been reported. Herein, we report a case of delayed IMH that occurred 3 months after cessation of pembrolizumab treatment in a patient with malignant  \n\n| Access this article online |  |\n| --- | --- |\n| Quick Response Code: | Website:\u003Cbr>[www.jpgmonline.com](www.jpgmonline.com) |\n| |  |\n|  | DOI:\u003Cbr>10.4103/jpgm.jpgm_834_22 |\n|  | PubMed ID:\u003Cbr>37376755 |\n\n􀂄 172 © 2023 Journal of Postgraduate Medicine | Published by Wolters Kluwer-Medknow  \nKang, et al.: Pembrolizumab‑induced delayed IMH  \nmelanoma and the associated histopathological findings in the liver.  \nCase Report  \nA male patient in his 40s visited the hospital because of blurred vision and periorbital pain in the right eye for two weeks on October 7, 2021. The patient had no past medical history. His visual acuity in the right eye was decreased to 20/40, and that in the left eye was 20/20. Formal visual field testing demonstrated a right-sided superior nasal and inferior field defect. Brain magnetic resonance imaging (MRI) revealed an enhancing, 2.6 cm soft tissue lesion on the right posterior ethmoid sinus that involved the medial extraconal space","cbCailYpCHnRIzxv","https://ap.wps.com/l/cbCailYpCHnRIzxv","pdf",1310017,"English","# Abstract\n# Introduction\n# Case Report","[{\"question\":\"What is pembrolizumab and why can it cause immune-related adverse events?\",\"answer\":\"Pembrolizumab is a monoclonal antibody targeting PD-1, part of immune checkpoint inhibition. By upregulating immunity, it can trigger immune-related adverse events such as immune-mediated hepatitis.\"},{\"question\":\"When did the delayed immune-mediated hepatitis occur in this case?\",\"answer\":\"Delayed immune-mediated hepatitis developed 3 months after cessation of pembrolizumab, with severe liver injury detected at 158 days after initiation and 105 days after the last administration.\"},{\"question\":\"How was other liver injury causes evaluated before biopsy?\",\"answer\":\"The case report notes negative viral and autoimmune-related markers, normal coagulation markers, and an abdominal CT scan without structural liver or biliary abnormalities, leading to a liver biopsy for differential diagnosis.\"}]","Delayed immune-mediated hepatitis after three cycles of pembrolizumab for the treatment of sinonasal melanoma | PDF",1790266143]