What should you know about immunotherapy hepatitis?

Checkpoint inhibitor treatment helps immune cells recognise cancer, but the activated immune system can sometimes affect healthy liver tissue. Liver inflammation may cause no noticeable symptoms at first, which is why oncology teams commonly use blood tests to check liver enzymes and bilirubin during treatment. Abnormal results do not by themselves show the exact cause; medicines, infections, alcohol-related injury and cancer affecting the liver can also alter these tests.

Possible symptoms include unusual tiredness, reduced appetite, nausea, discomfort under the right ribs, dark urine, pale stools, yellowing of the skin or eyes, and itching. The pattern and severity vary, and symptoms can appear during treatment or after a dose.

Tell your oncology team promptly about new symptoms, even if they seem mild. Do not stop, restart or change immunotherapy on your own. Your team may repeat blood tests, review other medicines and supplements, and decide whether treatment should pause while the liver is assessed. Treatment for immune-related inflammation may include a corticosteroid or another immune-calming medicine, guided by the clinical findings.

Until you receive advice, avoid alcohol and check before taking non-prescription pain medicines, herbal products or supplements, because some can put additional strain on the liver. Keep a record of symptoms, their start date and any recent medicines.

Contact your oncology service urgently for yellow skin or eyes, dark urine, repeated vomiting, increasing abdominal pain, marked drowsiness, confusion, bleeding, or an inability to keep fluids down. Seek emergency help for severe confusion, collapse or difficulty staying awake. Bring your medicine list and tell the team that you receive immunotherapy, so liver-related checks can begin without delay.

Which liver tests are abnormal, and when should they be repeated? Could another medicine or condition explain the result? Should I pause immunotherapy or any supplement? What symptoms should trigger a same-day call? If treatment is paused, how will the next decision be made?