Nivolumab-Associated Acute Liver Failure: A Report of Two Cases

Nivolumab is utilized for treating multiple advanced malignancies, with a fraction of patients experiencing immune-related side effects due to immune enhancement. Severe immune-related hepatic injury from nivolumab is very rare and typically responds well to corticosteroids. Here, we present two cases illustrating this phenomenon: one involving extensive-stage small cell carcinoma of the lung with disseminated liver and bone metastasis where nivolumab was administered as a fourth-line treatment and another involving uveal melanoma with liver metastasis where nivolumab was given as first-line palliative systemic therapy. Both cases demonstrated accelerated hepatic deterioration and unresponsiveness to timely steroid administration following the first cycle of nivolumab administration in 3-11 days.