{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T16:04:49Z","timestamp":1781712289941,"version":"3.54.5"},"reference-count":25,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2020,5,7]],"date-time":"2020-05-07T00:00:00Z","timestamp":1588809600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81901570"],"award-info":[{"award-number":["81901570"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004826","name":"Natural Science Foundation of Beijing Municipality","doi-asserted-by":"publisher","award":["7204328"],"award-info":[{"award-number":["7204328"]}],"id":[{"id":"10.13039\/501100004826","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004826","name":"Natural Science Foundation of Beijing Municipality","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004826","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007452","name":"Wu Jieping Medical Foundation","doi-asserted-by":"publisher","award":["320.6750.19094\u201045"],"award-info":[{"award-number":["320.6750.19094\u201045"]}],"id":[{"id":"10.13039\/100007452","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Thoracic Cancer"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:p>Pembrolizumab, an anti\u2010programmed cell death protein 1 (PD\u20101) antibody, has been shown to improve survival in patients with non\u2010small cell lung cancer (NSCLC) with high expression of programmed death\u2010ligand 1 (PD\u2010L1). Corticosteroids are the mainstay for most high\u2010grade immune\u2010related adverse events (irAEs) such as pembrolizumab\u2010induced hepatitis. However, the dose and duration of corticosteroid therapy are not well defined. The objective of this case report was to describe a new treatment pattern for severe immune checkpoint inhibitor\u2010associated hepatitis. Here, we report the case of a patient with metastatic lung adenocarcinoma who developed grade 3 immunotherapy\u2010induced hepatitis after the first cycle of pembrolizumab. Alanine aminotransferase (ALT) levels peaked at 233 U\/L. Hepatitis was alleviated after the administration of methylprednisolone. Therefore, we retreated the patient with pembrolizumab. However, aminotransferase levels increased again after the initiation of low\u2010dose methylprednisolone or the reuse of pembrolizumab. Finally, hepatitis was controlled with low\u2010dose methylprednisolone plus bicyclol, a Chinese hepatoprotective agent. Although the patient had been on low\u2010dose methylprednisolone therapy for about six months, he showed a prompt response. During this period, we also found a dramatic decrease in the neutrophil\u2010lymphocyte ratio (NLR), senescent T cells (CD8<jats:sup>+<\/jats:sup>CD28<jats:sup>\u2212<\/jats:sup>CD57<jats:sup>+<\/jats:sup>), and myeloid\u2010derived suppressor cells (MDSCs) in the peripheral blood of the patient. To our knowledge, this is the first case report of successful management of grade 3 pembrolizumab\u2010induced hepatitis with a combination of low\u2010dose corticosteroids and bicyclol. The durable clinical response and changes in blood biomarkers indicate that low doses of corticosteroids do not compromise the efficacy of immune checkpoint inhibitors (ICIs). Therefore, this case may provide a new treatment pattern for severe immunotherapy\u2010induced hepatitis.<\/jats:p>","DOI":"10.1111\/1759-7714.13463","type":"journal-article","created":{"date-parts":[[2020,5,7]],"date-time":"2020-05-07T13:49:45Z","timestamp":1588859385000},"page":"2023-2030","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Compromise or not? A case report of successful treatment of pembrolizumab\u2010induced hepatitis in a patient with non\u2010small cell lung cancer with low\u2010dose methylprednisolone and bicyclol"],"prefix":"10.1111","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9735-0722","authenticated-orcid":false,"given":"Yan'e","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Medical Oncology and Radiation Sickness Peking University Third Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3338-8139","authenticated-orcid":false,"given":"Jie","family":"Zhang","sequence":"additional","affiliation":[{"name":"Center of Basic Medical Research, Institute of Medical Innovation and Research Peking University Third Hospital  Beijing China"},{"name":"Biobank, Peking University Third Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongnan","family":"Yin","sequence":"additional","affiliation":[{"name":"Center of Basic Medical Research, Institute of Medical Innovation and Research Peking University Third Hospital  Beijing China"},{"name":"Biobank, Peking University Third Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Pathology, School of Basic Medical Sciences, Third Hospital Peking University Health Science Center  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1507-7193","authenticated-orcid":false,"given":"Lixiang","family":"Xue","sequence":"additional","affiliation":[{"name":"Center of Basic Medical Research, Institute of Medical Innovation and Research Peking University Third Hospital  Beijing China"},{"name":"Biobank, Peking University Third Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7939-4820","authenticated-orcid":false,"given":"Baoshan","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology and Radiation Sickness Peking University Third Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,5,7]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1606774"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1801946"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2019.0013"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdx225"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40425-017-0300-z"},{"key":"e_1_2_6_7_1","volume-title":"Common Terminology Criteria for Adverse Events (CTCAE), Version 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