Checkpoint inhibitor-induced hepatotoxicity: Role of liver biopsy and management approach

Table 1 Pros and cons on the indication for liver biopsy in clinical practice

Benefits	Limitations
To rule out pre-existing liver diseases	Invasiveness
To confirm diagnosis (i.e.; granulomas)	Cost
Differentiate anti-PD1/PD-L1 from anti-CTLA4- induced DILI	Pathognomic histological features are lacking
To establish the severity of liver injury.	Unclear influence on patient management
To discriminate ICIs-induced DILI from typical seronegative classical AIH	Biochemical features might be sufficient
To assess a possible chronicity evolution

AIH: Autoimmune hepatitis; DILI: Drug-induced liver injury; ICIs: Immunological checkpoint inhibitors; PD1: Programmed cell death protein-1.