Cholangitis Induced by Immune Checkpoint Inhibitors and Its Treatment Options

Immune checkpoint inhibitors (ICIs) are remarkable anticancer therapies, that have revolutionized the oncological prognosis of many cancers. The considerable efficacy of ICIs is associated with the onset of more or less serious immune-related adverse effects (irAEs) affecting several organs, which can concern up to 70% of patients, due to a loss of selftolerance during the restauration of antitumor immunity. Checkpoint inhibitor-induced liver injury (CHILI), which may occur in up to 25% of patients, are treated with steroids as firstline treatment, and immunosuppressive drugs in second-line. Recently, ICI-induced cholangitis has been described as an emerging irAE. Hence, Pi et al. reviewed all the 53 published cases of ICI-induced cholangitis and compared the different types of bile duct involvement. We recently described CHILI according to their biological profile: cholestatic, hepatocellular or mixed. Cholestatic profiles were associated with macroscopic and/or microscopic bile duct damage, and time to resolution was significantly longer. More recently, Parlati et al. and Onoyama et al. described a poorer response to steroids in cases of biliary histological damage or ICI-induced sclerosing cholangitis. The latest ESMO guidelines included for the first time the management of cholangitis, which is succinct and still poorly documented. The aim of this study is therefore to analyze the cases of ICI-induced cholangitis reported in the French pharmacovigilance system, in order to describe their clinical characteristics, evolution and outcome.