Balancing act: Tapering mycophenolate mofetil in immune checkpoint inhibitor hepatitis-strategies, outcomes, and risks

Table 3 Summary of studies reporting rechallenge outcomes in immune checkpoint inhibitor hepatitis

Ref.	Cancer type	Immunotherapy type	Risk of recurrent ICI with rechallenge
Li et al[63]	Melanoma	Anti-CTLA-4, Anti-PD-1, Anti-PD-L1, Combination (CTLA-4 + PD-1)	12.9% (4/31) developed recurrent ICI hepatitis; higher recurrence when rechallenged with same ICI class
Riveiro-Barciela et al[64]	Multiple (not specified)	Mostly Anti-PD-1 or Anti-PD-L1 monotherapy	34.8% (8/23) recurrence of ICI hepatitis, including 1 case of grade 4 hepatitis with liver failure
Hwang et al[20]	Mixed	Mixed	About 22% recurrence rate among those rechallenged (of about 40% who were rechallenged out of 1856 patients)
Haanen et al[60]	Not specified	Rechallenge strategy with concurrent immunosuppression (e.g., Tocilizumab)	No direct recurrence data; prophylactic strategy proposed, limited evidence for efficacy in ICI hepatitis
Pollack et al[66]	Metastatic melanoma	Anti-CTLA-4 + Anti-PD-1 initially; Anti-PD-1 monotherapy on rechallenge	16% recurrence in patients previously on MMF vs 22% in steroid-only group; higher risk if still on steroids

CTLA-4: Cytotoxic T-lymphocyte associated antigen 4; ICI: Immune checkpoint inhibitor; MMF: Mycophenolate mofetil; PD-1: Programmed cell death protein 1; PDL-1: Programmed death-ligand 1.