{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:36:04Z","timestamp":1787027764227,"version":"build-2736575974"},"reference-count":127,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,5,28]],"date-time":"2024-05-28T00:00:00Z","timestamp":1716854400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Primary liver cancer is one of the leading causes of cancer mortality worldwide, with hepatocellular carcinoma (HCC) being the most prevalent type of liver cancer. The prognosis of patients with advanced, unresectable HCC has historically been poor. However, with the emergence of immunotherapy, specifically immune checkpoint inhibitors (ICIs), there is reason for optimism. Nevertheless, ICIs do not come without risk, especially when administered in patients with HCC, given their potential underlying poor hepatic reserve. Given their novelty in the management of HCC, there are few studies to date specifically investigating ICI-related side effects on the liver in patients with underlying HCC. This review will serve as a guide for clinicians on ICIs\u2019 role in the management of HCC and their potential side effect profile. There will be a discussion on ICI-related hepatotoxicity, the potential for hepatitis B and C reactivation with ICI use, the potential for the development of autoimmune hepatitis with ICI use, and the risk of gastrointestinal bleeding with ICI use. As ICIs become more commonplace as a treatment option in patients with advanced HCC, it is imperative that clinicians not only understand the mechanism of action of such agents but also understand and are able to identify hepatic-related side effects.<\/jats:p>","DOI":"10.3390\/cancers16112042","type":"journal-article","created":{"date-parts":[[2024,5,28]],"date-time":"2024-05-28T07:38:39Z","timestamp":1716881919000},"page":"2042","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Immune Checkpoint Inhibitors in Hepatocellular Carcinoma and Their Hepatic-Related Side Effects: A Review"],"prefix":"10.3390","volume":"16","author":[{"suffix":"Jr.","given":"Thomas M.","family":"Ruli","sequence":"first","affiliation":[{"name":"Internal Medicine Residency Program, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ethan D.","family":"Pollack","sequence":"additional","affiliation":[{"name":"Internal Medicine Residency Program, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9918-1248","authenticated-orcid":false,"given":"Atul","family":"Lodh","sequence":"additional","affiliation":[{"name":"Internal Medicine Residency Program, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"Charles D.","family":"Evers","sequence":"additional","affiliation":[{"name":"Internal Medicine Residency Program, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher A.","family":"Price","sequence":"additional","affiliation":[{"name":"Internal Medicine Residency Program, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Shoreibah","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1002\/ijc.32723","article-title":"International Trends in Hepatocellular Carcinoma Incidence, 1978\u20132012","volume":"147","author":"Petrick","year":"2019","journal-title":"Int. J. Cancer"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1002\/hep.29498","article-title":"Projections of Primary Liver Cancer to 2030 in 30 Countries Worldwide","volume":"67","author":"Valery","year":"2017","journal-title":"Hepatology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e5904","DOI":"10.1097\/MD.0000000000005904","article-title":"Mortality Assessment of Patients with Hepatocellular Carcinoma according to Underlying Disease and Treatment Modalities","volume":"96","author":"Golabi","year":"2017","journal-title":"Medicine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"4115","DOI":"10.3748\/wjg.v20.i15.4115","article-title":"Hepatocellular Carcinoma Review: Current Treatment, and Evidence-Based Medicine","volume":"20","author":"Raza","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1007\/s00432-014-1806-0","article-title":"Management of Hepatocellular Carcinoma","volume":"141","author":"Fitzmorris","year":"2014","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1038\/s41575-021-00438-0","article-title":"Advances in Immunotherapy for Hepatocellular Carcinoma","volume":"18","author":"Sangro","year":"2021","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3044","DOI":"10.3390\/curroncol29050247","article-title":"Immune Checkpoint Inhibitors in Cancer Therapy","volume":"29","author":"Shiravand","year":"2022","journal-title":"Curr. Oncol."},{"key":"ref_8","unstructured":"Swoboda, A., and Nanda, R. (2018). Optimizing Breast Cancer Management, Springer."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"van Doorn, D.J., Takkenberg, R.B., and Kl\u00fcmpen, H.-J. (2020). Immune Checkpoint Inhibitors in Hepatocellular Carcinoma: An Overview. Pharmaceuticals, 14.","DOI":"10.3390\/ph14010003"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1038\/s41571-019-0218-0","article-title":"Adverse Effects of Immune-Checkpoint Inhibitors: Epidemiology, Management and Surveillance","volume":"16","author":"Martins","year":"2019","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_11","unstructured":"Asafo-Agyei, K.O., and Samant, H. (2023, November 01). Hepatocellular Carcinoma, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK559177\/."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.3748\/wjg.v29.i6.1054","article-title":"Immunotherapy for Hepatocellular Carcinoma: Current Status and Future Perspectives","volume":"29","author":"Mandlik","year":"2023","journal-title":"World J. Gastroenterol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"896752","DOI":"10.3389\/fimmu.2022.896752","article-title":"Advances in Immune Checkpoint Inhibitors for Advanced Hepatocellular Carcinoma","volume":"13","author":"Chen","year":"2022","journal-title":"Front. Immunol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.canlet.2019.12.002","article-title":"Immunotherapy for Hepatocellular Carcinoma","volume":"470","author":"Zongyi","year":"2020","journal-title":"Cancer Lett."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1192506","DOI":"10.3389\/fimmu.2023.1192506","article-title":"Immunotherapy of Hepatocellular Carcinoma: Recent Progress and New Strategy","volume":"14","author":"Li","year":"2023","journal-title":"Front. Immunol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1146\/annurev.immunol.25.022106.141609","article-title":"Immunosuppressive Strategies That Are Mediated by Tumor Cells","volume":"25","author":"Rabinovich","year":"2007","journal-title":"Annu. Rev. Immunol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1146\/annurev.immunol.22.012703.104803","article-title":"The Three Es of Cancer Immunoediting","volume":"22","author":"Dunn","year":"2004","journal-title":"Annu. Rev. Immunol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1379","DOI":"10.1002\/hep.24508","article-title":"Cross-Presentation of Antigen by Diverse Subsets of Murine Liver Cells","volume":"54","author":"Ebrahimkhani","year":"2011","journal-title":"Hepatology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1038\/nri.2017.11","article-title":"Liver Macrophages in Tissue Homeostasis and Disease","volume":"17","author":"Krenkel","year":"2017","journal-title":"Nat. Rev. Immunol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2009","DOI":"10.4049\/jimmunol.1201937","article-title":"Hepatic Stellate Cells Preferentially Induce Foxp3+ Regulatory T Cells by Production of Retinoic Acid","volume":"190","author":"Dunham","year":"2013","journal-title":"J. Immunol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1038\/s41575-018-0020-y","article-title":"Liver Sinusoidal Endothelial Cells\u2014Gatekeepers of Hepatic Immunity","volume":"15","author":"Shetty","year":"2018","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1200\/EDBK_156572","article-title":"Basic Overview of Current Immunotherapy Approaches in Cancer","volume":"36","author":"Velcheti","year":"2016","journal-title":"Am. Soc. Clin. Oncol. Educ. Book"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1038\/s41422-020-0343-4","article-title":"Immune Checkpoint Signaling and Cancer Immunotherapy","volume":"30","author":"He","year":"2020","journal-title":"Cell Res."},{"key":"ref_24","unstructured":"Van Coillie, S., Wiernicki, B., and Xu, J. (2020). Regulation of Cancer Immune Checkpoints, Springer. Advances in Experimental Medicine and Biology."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1007\/s00262-019-02299-8","article-title":"The Effect of Anti-CTLA4 Treatment on Peripheral and Intra-Tumoral T Cells in Patients with Hepatocellular Carcinoma","volume":"68","author":"Agdashian","year":"2019","journal-title":"Cancer Immunol. Immunother."},{"key":"ref_26","first-page":"45","article-title":"Current Progress and Prospect of Immune Checkpoint Inhibitors in Hepatocellular Carcinoma (Review)","volume":"20","author":"Zeng","year":"2020","journal-title":"Oncol. Lett."},{"key":"ref_27","first-page":"727","article-title":"PD-1\/PD-L1 Pathway: Current Researches in Cancer","volume":"10","author":"Han","year":"2020","journal-title":"Am. J. Cancer Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1182\/blood-2008-12-195792","article-title":"Tumor Antigen\u2013Specific CD8 T Cells Infiltrating the Tumor Express High Levels of PD-1 and Are Functionally Impaired","volume":"114","author":"Ahmadzadeh","year":"2009","journal-title":"Blood"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1038\/bjc.2015.101","article-title":"IFN-\u03b3 from Lymphocytes Induces PD-L1 Expression and Promotes Progression of Ovarian Cancer","volume":"112","author":"Abiko","year":"2015","journal-title":"Br. J. Cancer"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2038","DOI":"10.1002\/hep.28710","article-title":"Programmed Death Ligand 1 Expression in Hepatocellular Carcinoma: Relationship with Clinical and Pathological Features","volume":"64","author":"Calderaro","year":"2016","journal-title":"Hepatology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"5023","DOI":"10.2147\/OTT.S105862","article-title":"PD-L1 Expression in Human Cancers and Its Association with Clinical Outcomes","volume":"9","author":"Yu","year":"2016","journal-title":"OncoTargets Ther."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.jhep.2013.02.022","article-title":"A Clinical Trial of CTLA-4 Blockade with Tremelimumab in Patients with Hepatocellular Carcinoma and Chronic Hepatitis C","volume":"59","author":"Sangro","year":"2013","journal-title":"J. Hepatol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"4073","DOI":"10.1200\/JCO.2017.35.15_suppl.4073","article-title":"Phase I\/II Study of Durvalumab and Tremelimumab in Patients with Unresectable Hepatocellular Carcinoma (HCC): Phase I Safety and Efficacy Analyses","volume":"35","author":"Kelley","year":"2017","journal-title":"J. Clin. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2991","DOI":"10.1200\/JCO.20.03555","article-title":"Safety, Efficacy, and Pharmacodynamics of Tremelimumab plus Durvalumab for Patients with Unresectable Hepatocellular Carcinoma: Randomized Expansion of a Phase I\/II Study","volume":"39","author":"Kelley","year":"2021","journal-title":"J. Clin. Oncol."},{"key":"ref_35","first-page":"EVIDoa2100070","article-title":"Tremelimumab plus Durvalumab in Unresectable Hepatocellular Carcinoma","volume":"1","author":"Lau","year":"2022","journal-title":"NEJM Evid."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"4152","DOI":"10.3748\/wjg.v24.i36.4152","article-title":"Ten Years of Sorafenib in Hepatocellular Carcinoma: Are There Any Predictive and\/or Prognostic Markers?","volume":"24","author":"Marisi","year":"2018","journal-title":"World J. Gastroenterol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e204564","DOI":"10.1001\/jamaoncol.2020.4564","article-title":"Efficacy and Safety of Nivolumab plus Ipilimumab in Patients with Advanced Hepatocellular Carcinoma Previously Treated with Sorafenib","volume":"6","author":"Yau","year":"2020","journal-title":"JAMA Oncol."},{"key":"ref_38","unstructured":"(2023, December 01). CTG Labs-NCBI, Available online: https:\/\/clinicaltrials.gov\/study\/NCT04039607."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"898964","DOI":"10.3389\/fonc.2022.898964","article-title":"Immune Checkpoint Inhibitors for Advanced Hepatocellular Carcinoma: Monotherapies and Combined Therapies","volume":"12","author":"Ouyang","year":"2022","journal-title":"Front. Oncol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2492","DOI":"10.1016\/S0140-6736(17)31046-2","article-title":"Nivolumab in Patients with Advanced Hepatocellular Carcinoma (CheckMate 040): An Open-Label, Non-Comparative, Phase 1\/2 Dose Escalation and Expansion Trial","volume":"389","author":"Sangro","year":"2017","journal-title":"Lancet"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"v874","DOI":"10.1093\/annonc\/mdz394.029","article-title":"CheckMate 459: A Randomized, Multi-Center Phase III Study of Nivolumab (NIVO) vs Sorafenib (SOR) as First-Line (1L) Treatment in Patients (Pts) with Advanced Hepatocellular Carcinoma (AHCC)","volume":"30","author":"Yau","year":"2019","journal-title":"Ann. Oncol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1016\/S1470-2045(18)30351-6","article-title":"Pembrolizumab in Patients with Advanced Hepatocellular Carcinoma Previously Treated with Sorafenib (KEYNOTE-224): A Non-Randomised, Open-Label Phase 2 Trial","volume":"19","author":"Zhu","year":"2018","journal-title":"Lancet Oncol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1200\/JCO.19.01307","article-title":"Pembrolizumab as Second-Line Therapy in Patients with Advanced Hepatocellular Carcinoma in KEYNOTE-240: A Randomized, Double-Blind, Phase III Trial","volume":"38","author":"Finn","year":"2020","journal-title":"J. Clin. Oncol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1200\/JCO.22.00620","article-title":"Pembrolizumab versus Placebo as Second-Line Therapy in Patients from Asia with Advanced Hepatocellular Carcinoma: A Randomized, Double-Blind, Phase III Trial","volume":"41","author":"Qin","year":"2022","journal-title":"J. Clin. Oncol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1016\/S1470-2045(20)30156-X","article-title":"Atezolizumab with or without Bevacizumab in Unresectable Hepatocellular Carcinoma (GO30140): An Open-Label, Multicentre, Phase 1b Study","volume":"21","author":"Lee","year":"2020","journal-title":"Lancet Oncol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1894","DOI":"10.1056\/NEJMoa1915745","article-title":"Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma","volume":"382","author":"Finn","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"4071","DOI":"10.1200\/JCO.2017.35.15_suppl.4071","article-title":"Safety and Clinical Activity of Durvalumab Monotherapy in Patients with Hepatocellular Carcinoma (HCC)","volume":"35","author":"Wainberg","year":"2017","journal-title":"J. Clin. Oncol."},{"key":"ref_48","unstructured":"(2023, December 01). AstraZeneca. A Phase III, Randomized, Double-Blind, Placebo-Controlled, Multi Center Study of Durvalumab Monotherapy or in Combination with Bevacizumab as Adjuvant Therapy in Patients with Hepatocellular Carcinoma Who Are at High Risk of Recurrence after Curative Hepatic Resection or Ablation, Available online: https:\/\/clinicaltrials.gov\/study\/NCT03847428."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"S202","DOI":"10.1016\/j.annonc.2020.04.429","article-title":"P-347 A phase 3, randomized, double-blind, placebo-controlled study of transarterial chemoembolization combined with durvalumab or durvalumab plus bevacizumab therapy in patients with locoregional hepatocellular carcinoma: EMERALD-1","volume":"31","author":"Bruno","year":"2020","journal-title":"Ann. Oncol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/j.jhep.2019.10.021","article-title":"Diagnosis and Management of Toxicities of Immune Checkpoint Inhibitors in Hepatocellular Carcinoma","volume":"72","author":"Sangro","year":"2020","journal-title":"J. Hepatol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1055\/s-0038-1676806","article-title":"Inflammation and Liver Cancer: Molecular Mechanisms and Therapeutic Targets","volume":"39","author":"Yang","year":"2019","journal-title":"Semin. Liver Dis."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1077468","DOI":"10.3389\/fphar.2022.1077468","article-title":"Immune-Mediated Hepatitis Induced by Immune Checkpoint Inhibitors: Current Updates and Future Perspectives","volume":"13","author":"Liu","year":"2023","journal-title":"Front. Pharmacol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"5376","DOI":"10.3748\/wjg.v27.i32.5376","article-title":"Immune Checkpoint Inhibitor-Related Hepatotoxicity: A Review","volume":"27","author":"Remash","year":"2021","journal-title":"World J. Gastroenterol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e000042","DOI":"10.1136\/esmoopen-2016-000042","article-title":"Cancer and Liver Cirrhosis: Implications on Prognosis and Management","volume":"1","author":"Pinter","year":"2016","journal-title":"ESMO Open"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1002\/ijc.30678","article-title":"Risk of Hepatotoxicity in Cancer Patients Treated with Immune Checkpoint Inhibitors: A Systematic Review and Meta-Analysis of Published Data","volume":"141","author":"Wang","year":"2017","journal-title":"Int. J. Cancer"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/S1470-2045(17)30231-0","article-title":"Ipilimumab 10 Mg\/Kg versus Ipilimumab 3 Mg\/Kg in Patients with Unresectable or Metastatic Melanoma: A Randomised, Double-Blind, Multicentre, Phase 3 Trial","volume":"18","author":"Ascierto","year":"2017","journal-title":"Lancet Oncol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"108377","DOI":"10.1016\/j.clim.2020.108377","article-title":"Immune-Related Adverse Events of Checkpoint Inhibitors: Insights into Immunological Dysregulation","volume":"213","author":"Yang","year":"2020","journal-title":"Clin. Immunol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.semcancer.2019.06.012","article-title":"Autoimmunity, Checkpoint Inhibitor Therapy and Immune-Related Adverse Events: A Review","volume":"64","author":"Khan","year":"2020","journal-title":"Semin. Cancer Biol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1007\/s10637-013-9939-6","article-title":"Ipilimumab Associated Hepatitis: Imaging and Clinicopathologic Findings","volume":"31","author":"Kim","year":"2013","journal-title":"Investig. New Drugs"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1016\/j.jhep.2018.03.034","article-title":"Immune-Related Hepatitis with Immunotherapy: Are Corticosteroids Always Needed?","volume":"69","author":"Gauci","year":"2018","journal-title":"J. Hepatol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1396","DOI":"10.1016\/j.jhep.2018.08.014","article-title":"Incidence of Grade 3-4 Liver Injury under Immune Checkpoints Inhibitors: A Retrospective Study","volume":"69","author":"Parlati","year":"2018","journal-title":"J. Hepatol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1080\/17425255.2019.1574744","article-title":"Hepatotoxicity Induced by Immune Checkpoint Inhibitors: A Comprehensive Review Including Current and Alternative Management Strategies","volume":"15","author":"Jennings","year":"2019","journal-title":"Expert Opin. Drug Metab. Toxicol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1016\/j.jhep.2018.06.012","article-title":"Mortality due to Immunotherapy Related Hepatitis","volume":"69","author":"Bhave","year":"2018","journal-title":"J. Hepatol."},{"key":"ref_64","unstructured":"LiverTox (2023, December 01). Roussel Uclaf Causality Assessment Method (RUCAM) in Drug Induced Liver Injury, Available online: https:\/\/pubmed.ncbi.nlm.nih.gov\/31689029."},{"key":"ref_65","unstructured":"LiverTox (2023, December 01). Clinical Course and Diagnosis of Drug Induced Liver Disease, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK548733\/."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1991","DOI":"10.1007\/s00262-023-03436-0","article-title":"Multidisciplinary Recommendations for Essential Baseline Functional and Laboratory Tests to Facilitate Early Diagnosis and Management of Immune-Related Adverse Events among Cancer Patients","volume":"72","author":"Espinosa","year":"2023","journal-title":"Cancer Immunol. Immunother."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Teschke, R., and Danan, G. (2021). Idiosyncratic Drug-Induced Liver Injury (DILI) and Herb-Induced Liver Injury (HILI): Diagnostic Algorithm Based on the Quantitative Roussel Uclaf Causality Assessment Method (RUCAM). Diagnostics, 11.","DOI":"10.3390\/diagnostics11030458"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1002\/hep.28813","article-title":"Liver Injury from Herbal and Dietary Supplements","volume":"65","author":"Navarro","year":"2016","journal-title":"Hepatology"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.4254\/wjh.v14.i7.1269","article-title":"Checkpoint Inhibitor-Induced Hepatotoxicity: Role of Liver Biopsy and Management Approach","volume":"14","author":"Bessone","year":"2022","journal-title":"World J. Hepatol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"5088","DOI":"10.1002\/cncr.33165","article-title":"Outcomes after Resumption of Immune Checkpoint Inhibitor Therapy after High-Grade Immune-Mediated Hepatitis","volume":"126","author":"Li","year":"2020","journal-title":"Cancer"},{"key":"ref_71","first-page":"1194","article-title":"Immunotherapy-Induced Hepatotoxicity: A Review","volume":"10","author":"Wu","year":"2022","journal-title":"J. Clin. Transl. Hepatol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1016\/j.jhep.2018.01.033","article-title":"Characterization of Liver Injury Induced by Cancer Immunotherapy Using Immune Checkpoint Inhibitors","volume":"68","author":"Michot","year":"2018","journal-title":"J. Hepatol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1906","DOI":"10.1111\/liv.14489","article-title":"Immune-Related Hepatitis Related to Checkpoint Inhibitors: Clinical and Prognostic Factors","volume":"40","author":"Mar","year":"2020","journal-title":"Liver Int."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1002\/hep.31227","article-title":"Hepatotoxicity from Immune Checkpoint Inhibitors: A Systematic Review and Management Recommendation","volume":"72","author":"Thoetchai","year":"2020","journal-title":"Hepatology"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1136\/flgastro-2018-101146","article-title":"Immunotherapy-Related Hepatitis: Real-World Experience from a Tertiary Centre","volume":"10","author":"Cheung","year":"2019","journal-title":"Frontline Gastroenterol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1016\/j.jhep.2019.02.014","article-title":"EASL Clinical Practice Guidelines: Drug-Induced Liver Injury","volume":"70","author":"Andrade","year":"2019","journal-title":"J. Hepatol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1016\/j.annonc.2022.10.001","article-title":"Management of Toxicities from Immunotherapy: ESMO Clinical Practice Guideline for Diagnosis, Treatment and Follow-Up","volume":"33","author":"Haanen","year":"2022","journal-title":"Ann. Oncol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1714","DOI":"10.1200\/JCO.2017.77.6385","article-title":"Management of Immune-Related Adverse Events in Patients Treated with Immune Checkpoint Inhibitor Therapy: American Society of Clinical Oncology Clinical Practice Guideline","volume":"36","author":"Brahmer","year":"2018","journal-title":"J. Clin. Oncol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1186\/s40425-017-0300-z","article-title":"Managing Toxicities Associated with Immune Checkpoint Inhibitors: Consensus Recommendations from the Society for Immunotherapy of Cancer (SITC) Toxicity Management Working Group","volume":"5","author":"Puzanov","year":"2017","journal-title":"J. Immunother. Cancer"},{"key":"ref_80","first-page":"732","article-title":"Retreatment with Immune Checkpoint Inhibitors after a Severe Immune-Related Hepatitis: Results from a Prospective Multicenter Study","volume":"21","author":"Salcedo","year":"2022","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/j.jhep.2006.05.013","article-title":"The Contributions of Hepatitis B Virus and Hepatitis c Virus Infections to Cirrhosis and Primary Liver Cancer Worldwide","volume":"45","author":"Perz","year":"2006","journal-title":"J. Hepatol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"5759","DOI":"10.3748\/wjg.v26.i38.5759","article-title":"Molecular Mechanisms of Viral Hepatitis Induced Hepatocellular Carcinoma","volume":"26","author":"Lau","year":"2020","journal-title":"World J. Gastroenterol."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1093\/nsr\/nwu038","article-title":"The Hepatitis B Virus-Associated Tumor Microenvironment in Hepatocellular Carcinoma","volume":"1","author":"Yang","year":"2014","journal-title":"Natl. Sci. Rev."},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Tu, T., Budzinska, M.A., Shackel, N.A., and Urban, S. (2017). HBV DNA Integration: Molecular Mechanisms and Clinical Implications. Viruses, 9.","DOI":"10.3390\/v9040075"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"S84","DOI":"10.1016\/j.jhep.2016.02.021","article-title":"Mechanisms of HBV-Induced Hepatocellular Carcinoma","volume":"64","author":"Levrero","year":"2016","journal-title":"J. Hepatol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.3748\/wjg.v22.i4.1461","article-title":"Metabolic Alterations and Hepatitis C: From Bench to Bedside","volume":"22","author":"Chang","year":"2016","journal-title":"World J. Gastroenterol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/bs.acr.2020.10.003","article-title":"Hepatitis c Virus Associated Hepatocellular Carcinoma","volume":"149","author":"Khatun","year":"2021","journal-title":"Adv. Cancer Res."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/j.dld.2020.08.041","article-title":"Hepatitis B Reactivation and Immune Check Point Inhibitors","volume":"53","author":"Godbert","year":"2021","journal-title":"Dig. Liver Dis."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"7675","DOI":"10.3748\/wjg.v20.i24.7675","article-title":"Hepatitis B Virus Reactivation in Patients with Hepatocellular Carcinoma Undergoing Anti-Cancer Therapy","volume":"20","author":"Jang","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1093\/annonc\/mdh430","article-title":"Hepatitis B reactivation in patients with hepatocellular carcinoma undergoing systemic chemotherapy","volume":"15","author":"Yeo","year":"2004","journal-title":"Ann. Oncol."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.1053\/j.gastro.2017.02.009","article-title":"Hepatitis B Reactivation Associated with Immune Suppressive and Biological Modifier Therapies: Current Concepts, Management Strategies, and Future Directions","volume":"152","author":"Loomba","year":"2017","journal-title":"Gastroenterology"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1016\/j.cgh.2021.06.019","article-title":"Risk of Hepatitis B Virus Reactivation in Patients Treated with Immunotherapy for Anti-Cancer Treatment","volume":"20","author":"Yoo","year":"2022","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1186\/s40249-023-01128-6","article-title":"Hepatitis B Reactivation in Cancer Patients Receiving Immune Checkpoint Inhibitors: A Systematic Review and Meta-Analysis","volume":"12","author":"Xia","year":"2023","journal-title":"Infect. Dis. Poverty"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"1274","DOI":"10.14309\/ajg.0000000000001142","article-title":"Hepatitis Flare during Immunotherapy in Patients with Current or Past Hepatitis B Virus Infection","volume":"116","author":"Wong","year":"2021","journal-title":"Am. J. Gastroenterol."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1186\/s40425-019-0808-5","article-title":"Hepatitis B Virus Reactivation in Cancer Patients with Positive Hepatitis B Surface Antigen Undergoing PD-1 Inhibition","volume":"7","author":"Zhang","year":"2019","journal-title":"J. Immunother. Cancer"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"e001072","DOI":"10.1136\/jitc-2020-001072","article-title":"Risk of HBV Reactivation in Patients with Immune Checkpoint Inhibitor-Treated Unresectable Hepatocellular Carcinoma","volume":"8","author":"Lee","year":"2020","journal-title":"J. Immunother. Cancer"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1111\/hepr.13699","article-title":"Novel Strategies for the Early Diagnosis of Hepatitis B Virus Reactivation","volume":"51","author":"Inoue","year":"2021","journal-title":"Hepatol. Res."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"e1694","DOI":"10.1038\/cddis.2015.42","article-title":"T-Cell Exhaustion in Chronic Hepatitis B Infection: Current Knowledge and Clinical Significance","volume":"6","author":"Ye","year":"2015","journal-title":"Cell Death Dis."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1053\/j.gastro.2013.12.036","article-title":"Hepatic Immune Regulation and Its Involvement in Viral Hepatitis Infection","volume":"146","author":"Knolle","year":"2014","journal-title":"Gastroenterology"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"e827","DOI":"10.1002\/onco.13739","article-title":"Safety of Immune Checkpoint Inhibitors in Patients with Cancer and Hepatitis c Virus Infection","volume":"26","author":"Alkrekshi","year":"2021","journal-title":"Oncologist"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"409","DOI":"10.2217\/imt-2020-0273","article-title":"Managing Viral Hepatitis in Cancer Patients under Immune Checkpoint Inhibitors: Should We Take the Risk?","volume":"13","author":"Vermassen","year":"2021","journal-title":"Immunotherapy"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.ejca.2018.09.017","article-title":"Anti-PD-1\/PD-L1 Immunotherapy in Patients with Solid Organ Transplant, HIV or Hepatitis B\/c Infection","volume":"104","author":"Tio","year":"2018","journal-title":"Eur. J. Cancer"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1016\/j.cmi.2022.02.042","article-title":"Hepatitis B Virus and Hepatitis c Virus Reactivation in Cancer Patients Receiving Novel Anticancer Therapies","volume":"28","author":"Mustafayev","year":"2022","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_104","first-page":"571A","article-title":"Safety of immune checkpoint inhibitors in cancer patients with chronic hepatitis C infection: A prospective observational study","volume":"72","author":"Yibirin","year":"2020","journal-title":"Hepatology"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"907591","DOI":"10.3389\/fimmu.2022.907591","article-title":"Immune-Mediated Hepatitis during Immune Checkpoint Inhibitor Cancer Immunotherapy: Lessons from Autoimmune Hepatitis and Liver Immunology","volume":"13","author":"Hercun","year":"2022","journal-title":"Front. Immunol."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1053\/j.semdp.2019.07.009","article-title":"Checkpoint Inhibitor-Induced Liver Injury: A Novel Form of Liver Disease Emerging in the Era of Cancer Immunotherapy","volume":"36","author":"Zen","year":"2019","journal-title":"Semin. Diagn. Pathol."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1038\/s41698-023-00380-1","article-title":"Immunosuppression for Immune-Related Adverse Events during Checkpoint Inhibition: An Intricate Balance","volume":"7","author":"Verheijden","year":"2023","journal-title":"NPJ Precis. Oncol."},{"key":"ref_108","first-page":"83","article-title":"Immune Checkpoint Inhibitor-Induced Hepatic Injury: A Clinicopathologic Review","volume":"2","author":"Taherian","year":"2022","journal-title":"J. Clin. Transl. Pathol."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"e001322","DOI":"10.1136\/jitc-2020-001322","article-title":"When Steroids Are Not Enough in Immune-Related Hepatitis: Current Clinical Challenges Discussed on the Basis of a Case Report","volume":"8","author":"Ziogas","year":"2020","journal-title":"J. ImmunoTherapy Cancer"},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1001\/jama.2023.5997","article-title":"Diagnosis and Management of Cirrhosis and Its Complications: A Review","volume":"329","author":"Tapper","year":"2023","journal-title":"JAMA"},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1002\/hep.1840160607","article-title":"Prevalence, Classification and Natural History of Gastric Varices: A Long-Term Follow-up Study in 568 Portal Hypertension Patients","volume":"16","author":"Sarin","year":"1992","journal-title":"Hepatology"},{"key":"ref_112","doi-asserted-by":"crossref","unstructured":"North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices (1988). Prediction of the First Variceal Hemorrhage in Patients with Cirrhosis of the Liver and Esophageal Varices. N. Engl. J. Med., 319, 983\u2013989.","DOI":"10.1056\/NEJM198810133191505"},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"1378","DOI":"10.1016\/j.cgh.2006.08.011","article-title":"Prevalence and Prognostic Significance of the Presence of Esophageal Varices in Patients with Hepatocellular Carcinoma","volume":"4","author":"Giannini","year":"2006","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/S1470-2045(20)30011-5","article-title":"Camrelizumab in Patients with Previously Treated Advanced Hepatocellular Carcinoma: A Multicentre, Open-Label, Parallel-Group, Randomised, Phase 2 Trial","volume":"21","author":"Qin","year":"2020","journal-title":"Lancet Oncol."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"1811","DOI":"10.2217\/fon-2019-0097","article-title":"RATIONALE 301 Study: Tislelizumab versus Sorafenib as First-Line Treatment for Unresectable Hepatocellular Carcinoma","volume":"15","author":"Qin","year":"2019","journal-title":"Future Oncol."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1159\/000515553","article-title":"Pembrolizumab as Second-Line Therapy for Advanced Hepatocellular Carcinoma: A Subgroup Analysis of Asian Patients in the Phase 3 KEYNOTE-240 Trial","volume":"10","author":"Kudo","year":"2021","journal-title":"Liver Cancer"},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"8665","DOI":"10.3390\/curroncol30090628","article-title":"Current Evidence for Immune Checkpoint Inhibition in Advanced Hepatocellular Carcinoma","volume":"30","author":"Foy","year":"2023","journal-title":"Curr. Oncol."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1001\/jamaoncol.2023.2677","article-title":"Critical Appraisal of Guideline Recommendations on Systemic Therapies for Advanced Hepatocellular Carcinoma","volume":"10","author":"Cappuyns","year":"2023","journal-title":"JAMA Oncol."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1016\/j.jhep.2021.11.030","article-title":"Updated Efficacy and Safety Data from IMbrave150: Atezolizumab plus Bevacizumab vs. Sorafenib for Unresectable Hepatocellular Carcinoma","volume":"76","author":"Cheng","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"1922","DOI":"10.1097\/HEP.0000000000000466","article-title":"AASLD Practice Guidance on Prevention, Diagnosis, and Treatment of Hepatocellular Carcinoma","volume":"78","author":"Singal","year":"2023","journal-title":"Hepatology"},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"1328","DOI":"10.1056\/NEJMoa1917346","article-title":"Atezolizumab for First-Line Treatment of PD-L1\u2013Selected Patients with NSCLC","volume":"383","author":"Herbst","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"1788","DOI":"10.1038\/sj.bjc.6603813","article-title":"Mechanisms of Adverse Effects of Anti-VEGF Therapy for Cancer","volume":"96","author":"Kamba","year":"2007","journal-title":"Br. J. Cancer"},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"102179","DOI":"10.1016\/j.eclinm.2023.102179","article-title":"Effectiveness and Safety of Atezolizumab-Bevacizumab in Patients with Unresectable Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis","volume":"63","author":"Kulkarni","year":"2023","journal-title":"EClinicalMedicine"},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"2421","DOI":"10.1016\/j.cgh.2022.07.035","article-title":"Risk of Variceal Bleeding in Patients with Advanced Hepatocellular Carcinoma Receiving Atezolizumab\/Bevacizumab","volume":"21","author":"Ha","year":"2022","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_125","first-page":"2843","article-title":"A History of Variceal Bleeding Is Associated with Further Bleeding under Atezolizumab-Bevacizumab in Patients with HCC","volume":"42","author":"Larrey","year":"2022","journal-title":"Liver Int. Off. J. Int. Assoc. 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