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Jpn J Clin Oncol. 2017 Feb 11;47(2):175-178. doi: 10.1093/jjco/hyw167.

Severe hepatitis arising from ipilimumab administration, following melanoma treatment with nivolumab.

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Department of Dermatology, University of Tsukuba, Ibaraki, Japan.
Department of Dermatology, Hitachi General Hospital, Ibaraki, Japan.
Department of Gastroenterology, University of Tsukuba, Ibaraki, Japan.
Department of Medical Oncology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.


After 4 weeks of the last dose of nivolumab, a 59-year-old man with stage IV melanoma was subject to treatment with ipilimumab. After 5 weeks, the patient developed severe hepatitis, showing markedly elevated levels of both aspartate aminotransferase and alanine aminotransferase (>2000 U/l). Using pulse steroid therapy with 1000 mg/d of methylprednisolone, liver function initially improved, but then deteriorated upon dosage reduction. Subsequently, mycophenolate mofetil (MMF) was administered at a dose of 2 g/d in addition to the corticosteroid, which resulted in aspartate aminotransferase and alanine aminotransferase levels gradually improving to grade 1, and the corticosteroid dose was successfully reduced to 0.5 mg/kg/d of oral prednisolone. Liver function then remained stable when MMF was tapered. In conclusion, the use of MMF improved liver function in this patient with steroid-refractory hepatitis induced by immune checkpoint inhibitor administration.


melanoma; ipilimumab; nivolumab; hepatitis; mycophenolate mofetil

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