Liver function tests

And maybe, you know, things have changed and that's now, you know, it was there before, but now it's more recently gotten, it's a chronic problem, but it's now just recently gotten to the point where the blood tests are abnormal.

I think though it's important that when we look at these abnormal liver tests, they're also often called liver function tests.

or LFTs, but most of the tests that we've already described, those liver enzymes, AST, the ALT, and the alkaline phosphatase, those are just markers of liver irritation, and they really have nothing to do with liver function, really.

And those liver function tests are things like the bilirubin, which is the test that becomes elevated when you become jaundiced.

The albumin, which is the major protein that the liver makes, although that's not a great test because again, you can make tons of albumin, but you lose it, let's say in your urine, then it's going to be low and it has nothing to do with your liver.

I don't know, Jason, do you vary from the label recommendation or do you check labs at all?

Yeah, so I think one of the confusing aspects of the label is basically it talks about hepatic impairment, but it's really talking about child puke class scoring, which, by the way, does not include LFTs.

And that's really important.

These are patients with ascites or liver cirrhosis.

Sometimes they get a little rash or itchy skin, that's nothing to do.

Grade 2, mild to moderate to maybe grade 2 LFT abnormality or other lab work value abnormality, we usually hold a treatment and check, recheck the labs and consider resuming immunotherapy when symptoms or laboratory values revert to grade 1 or lower and Corticosteroids may be used, but we don't jump to the conclusions because sometimes it's chemotherapy side effects.

So I usually have them come back one or two days later for repeat labs.

If the labs are improving already without anything, it's probably chemo, not immunotherapy.

We usually manage those outpatients still.

And grade 4 toxicities, of course, permanent discontinuation of checkpoint inhibitors.

And we usually admit those endocrinopathies, you know, thyroiditis or hyperglycemia, you could resume therapy, but everything else, like LFT abnormalities and so forth, we usually hold treatment.

So this patient is receiving perioperative DERVA flaw, developed grade 2 immune-related colitis.

Sometimes, you know, they get a little rash or itchy skin, that's nothing to do.

Grade two, mild to moderate to maybe grade two LFT abnormality or other lab work value abnormality, we usually hold a treatment and check, recheck the labs and consider resuming immunotherapy when symptoms or laboratory values revert to grade one or lower.

Corticosteroids may be used, but we don't jump to the conclusions because sometimes it's chemotherapy side effects.

So I usually have them come back one or two days later for repeat labs.

We usually manage those outpatients still.

And grade 4 toxicities, of course, permanent discontinuation of checkpoint inhibitors.

And we usually admit those endocrinopathies, you know, thyroiditis or hyperglycemia, you could resume therapy, but everything else, like LFT abnormalities and so forth, we usually hold treatment.

So if this patient is receiving perioperative DERVA flaw, developed grade 2 immune-related colitis, what would your next steps now in the management of the patient care? One, continue immunotherapy without intervention.

Sometimes they get a little rash or itchy skin, that's nothing to do.

Grade 2, mild to moderate to maybe grade 2 LFT abnormality or other lab work value abnormality, we usually hold a treatment and check, recheck the labs and consider resuming immunotherapy when symptoms or laboratory values revert to grade 1 or lower and Corticosteroids may be used, but we don't jump to the conclusions because sometimes it's chemotherapy side effects.

So I usually have them come back one or two days later for repeat labs.

If the labs are improving already without anything, it's probably chemo, not immunotherapy.

We usually manage those outpatients still.

And grade 4 toxicities, of course, permanent discontinuation of checkpoint inhibitors.

And we usually admit those endocrinopathies, you know, thyroiditis or hyperglycemia, you could resume therapy, but everything else, like LFT abnormalities and so forth, we usually hold treatment.

So this patient is receiving perioperative DERVA flaw, developed grade 2 immune-related colitis.

Sometimes, you know, they get a little rash or itchy skin, that's nothing to do.

Grade two, mild to moderate to maybe grade two LFT abnormality or other lab work value abnormality, we usually hold a treatment and check, recheck the labs and consider resuming immunotherapy when symptoms or laboratory values revert to grade one or lower.

Corticosteroids may be used, but we don't jump to the conclusions because sometimes it's chemotherapy side effects.

So I usually have them come back one or two days later for repeat labs.

We usually manage those outpatients still.

And grade 4 toxicities, of course, permanent discontinuation of checkpoint inhibitors.

And we usually admit those endocrinopathies, you know, thyroiditis or hyperglycemia, you could resume therapy, but everything else, like LFT abnormalities and so forth, we usually hold treatment.

So if this patient is receiving perioperative DERVA flaw, developed grade 2 immune-related colitis, what would your next steps now in the management of the patient care? One, continue immunotherapy without intervention.

Sometimes they get a little rash or itchy skin, that's nothing to do.

Grade 2, mild to moderate to maybe grade 2 LFT abnormality or other lab work value abnormality, we usually hold a treatment and check, recheck the labs and consider resuming immunotherapy when symptoms or laboratory values revert to grade 1 or lower and Corticosteroids may be used, but we don't jump to the conclusions because sometimes it's chemotherapy side effects.

So I usually have them come back one or two days later for repeat labs.

If the labs are improving already without anything, it's probably chemo, not immunotherapy.

We usually manage those outpatients still.

And grade 4 toxicities, of course, permanent discontinuation of checkpoint inhibitors.

And we usually admit those endocrinopathies, you know, thyroiditis or hyperglycemia, you could resume therapy, but everything else, like LFT abnormalities and so forth, we usually hold treatment.

So this patient is receiving perioperative DERVA flaw, developed grade 2 immune-related colitis.

Sometimes, you know, they get a little rash or itchy skin, that's nothing to do.

Grade two, mild to moderate to maybe grade two LFT abnormality or other lab work value abnormality, we usually hold a treatment and check, recheck the labs and consider resuming immunotherapy when symptoms or laboratory values revert to grade one or lower.

Corticosteroids may be used, but we don't jump to the conclusions because sometimes it's chemotherapy side effects.

So I usually have them come back one or two days later for repeat labs.

We usually manage those outpatients still.

And grade 4 toxicities, of course, permanent discontinuation of checkpoint inhibitors.

And we usually admit those endocrinopathies, you know, thyroiditis or hyperglycemia, you could resume therapy, but everything else, like LFT abnormalities and so forth, we usually hold treatment.

So if this patient is receiving perioperative DERVA flaw, developed grade 2 immune-related colitis, what would your next steps now in the management of the patient care? One, continue immunotherapy without intervention.