cliot (version 1.0.0)

irae_hepatitis_grading: irAE Grading for Hepatitis (GI Toxicities)

Description

Calculates the CTCAE severity grade for immune-mediated hepatitis associated with immune checkpoint inhibitor (ICPi) therapy. Grading is based on the elevation of liver transaminases (AST/ALT) and Total Bilirubin relative to the Upper Limit of Normal (ULN).

Usage

irae_hepatitis_grading(ast, alt, total_bilirubin, ast_uln, alt_uln, bilirubin_uln)

Value

A list containing:

CTCAE_Grade

The calculated adverse event grade (0-4).

Definition

The criteria met for the specific grade.

Management_Recommendation

Guidance on ICPi continuation and immunosuppressive therapy based on ASCO guidelines.

Arguments

ast

Numeric. Patient's current AST level.

alt

Numeric. Patient's current ALT level.

total_bilirubin

Numeric. Patient's current Total Bilirubin level.

ast_uln

Numeric. The laboratory's Upper Limit of Normal for AST.

alt_uln

Numeric. The laboratory's Upper Limit of Normal for ALT.

bilirubin_uln

Numeric. The laboratory's Upper Limit of Normal for Total Bilirubin.

References

Brahmer JR, Lacchetti C, Schneider BJ, et al. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2018;36(17):1714-1768. doi:10.1200/JCO.2017.77.6385

Examples

# Example 1: Grade 3 Hepatitis
# AST 250 (ULN 40 -> 6.25x), Bili Normal
irae_hepatitis_grading(250, 40, 1.0, 40, 40, 1.2)

# Example 2: Grade 1 Hepatitis
# ALT 80 (ULN 40 -> 2x), Bili Normal
irae_hepatitis_grading(30, 80, 0.8, 40, 40, 1.2)