Early Recognition of Immune-Related Hepatitis During Avelumab Maintenance Therapy for Urothelial Carcinoma.

INTRODUCTION

Avelumab is recommended as maintenance therapy for advanced urothelial carcinoma after platinum chemotherapy; however, immune-related adverse events can be severe and refractory.

CASE PRESENTATION: A 79-year-old male developed immune-related hepatitis during avelumab maintenance therapy following gemcitabine plus carboplatin for metastatic recurrent urothelial carcinoma. Despite discontinuation of avelumab and treatment with high-dose corticosteroids, mycophenolate mofetil, and plasma exchange, liver failure progressed, leading to death on day 106.

CONCLUSION

Hepatic irAEs during avelumab therapy are rare but potentially fatal. Early recognition and aggressive multidisciplinary management are essential to improve outcomes.