Immune‑mediated hepatitis and hepatitis B virus reactivation induced by immunotherapy in hepatocellular carcinoma: A case report and literature review

Immune checkpoint inhibitors (ICIs) are commonly used in the treatment of hepatocellular carcinoma (HCC) and performing miracles, however, the immune‑related adverse events(irAE) should not be neglected. Here, we report a patient in their 40s with advanced HCC, who treated with anti-programmed death‑1(PD‑1) monoclonal antibody and experienced immune-mediated hepatitis (IMH) and simultaneously hepatitis B virus (HBV) reactivation. The patient developed fever in the third day after receiving immunotherapy, and severe IMH, manifested as depression, abdominal distension, ascites, repeated low fever and rapid deterioration of liver function within two months, the hepatitis B virus (HBV) DNA quantity was also observed increased significantly from 3.94E+01 IU/ml to 1.1E+04 IU/ml. After receiving corticosteroid impulse therapy, anti-hepatitis B virus therapy and other symptomatic treatments, he was recovered rapidly within one week. Eight months later, the patient received anti-programmed death ligand‑1 (PD-L1) monoclonal antibody, Envafolimab, combined with tyrosine kinase inhibitor based targeted therapy, however, severe irAE and reactivation of HBV didn’t reappear, which might be attributed to the difference of mechanism between anti-PD‑1 and anti-PD‑L1 therapies. In conclusion: Anti- PD-L1 may lead to less adverse effect on immune homeostatic and better safety than anti- PD‑1, besides, anti-PD-L1 therapy, such as Envafolimab, could participated in the immune regulation of anti-HBV. This case helps to strengthen the understanding of the difference between anti- PD‑1 and anti- PD‑L1 therapy, and also provides a hope for a better cure of clearing HBV.