What is immunotherapy related hepatitis?

Immunotherapy is a treatment for cancer that helps the immune system recognise, target, and eliminate cancer cells wherever they are in the body. Many cancers employ methods to hide themselves from the body’s immune cells. Immunotherapy blocks these evasion strategies, so the body’s immune system can recognise and kill the cancer cells. 

In some people, immunotherapy can also cause the immune system to attack normal tissues within the body, causing inflammation. Hepatitis is a term used to describe inflammation of the liver.

Your recent blood test results have diagnosed you with immunotherapy related hepatitis. We analysed different markers in your blood to check how well your liver is working and this has shown inflammation in your liver.

Immune related hepatitis common symptoms

Common symptoms of immune related hepatitis can include: 

  • Deranged blood test results.
  • Muscle or joint pain.
  • Feeling or being sick.
  • Feeling unusually tired all the time.
  • A general sense of feeling unwell.
  • Loss of appetite.
  • Dark urine.
  • Yellowing of the skin and eyes, known as jaundice.
  • Itchy skin.

How do we treat immunotherapy related hepatitis?

Medications which reduce inflammation within the liver are used to treat immunotherapy related hepatitis. These include steroids, also known as corticosteroids, such as prednisolone. Steroids work by suppressing the immune system to stop it from attacking your good cells and hopefully improve your symptoms.

Your immunotherapy treatment will be placed on hold until your blood results improve, and you will require close monitoring during this time.

How long will I have to take steroids?

Everyone is different and each person’s body responds differently. You will be monitored closely when you are on steroids to check they are working to reduce your symptoms.

Taking steroid tablets for less than three weeks is unlikely to cause any significant side effects. However, you may get some side effects if you need to take them for longer or at a high dose. Often, patients experience no side effects from steroids.

Steroid tablets side effects

Side effects of steroid tablets can include:

  • Indigestion or heartburn.
  • Increased appetite, which could lead to weight gain when used long term.
  • Difficulty sleeping.
  • Changes in mood and behaviour, such as feeling irritable or anxious.
  • An increased risk of infections – especially chickenpox, shingles, and measles
  • High blood sugars or diabetes.
  • Weakening of the bones (osteoporosis).
  • High blood pressure.
  • Cushing's syndrome – which can cause symptoms such as thin skin that bruises easily, a build-up of fat on the neck and shoulders and a red, puffy, rounded face.
  • Eye conditions, such as glaucoma and cataracts.
  • Mental health problems, such as depression or suicidal thoughts.

Most side effects will pass once treatment stops. Tell your doctor or nurse if you notice any new symptoms. If possible, you should take your steroids in the morning to reduce trouble sleeping.

You will be given a tablet to take alongside your steroids to protect your stomach from irritation and it is also recommended to take your steroid tablets with food.

If you are on steroids for more than three weeks, your doctor or specialist nurse might prescribe a bone strengthening drug to prevent the weakening of your bones and a low dose of antibiotics to prevent you from getting an infection.

If your symptoms do not improve on steroids, we sometimes use other drugs in addition to supress the immune system.