Clinical, Endoscopic, and Pathological Characteristics of Immune Checkpoint Inhibitor-Induced Gastroenterocolitis

Hayashi, Yukie; Hosoe, Naoki; Takabayashi, Kaoru; Kamiya, Kenji; Tsugaru, Kai; Shimozaki, Keitaro; Hirata, Kenro; Fukuhara, Kayoko; Fukuhara, Seiichiro; Murata, Makoto; Sujino, Tomohisa; Sukawa, Yasutaka; Hamamoto, Yasuo; Takaishi, Hiromasa; Shimoda, Masayuki; Ogata, Haruhiko; Kanai, Takanori

doi:10.1007/s10620-020-06441-w

Cited by 28 publications

(26 citation statements)

References 11 publications

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“…The histological features are largely similar to those of acute colitis [ 32 , 33 ]. Cryptitis, intra-epithelial neutrophilic lymphocytes, mucosal ulcerations, crypt abscesses and apoptosis are common features in ICI-induced colitis [ 34 , 35 , 36 , 37 , 38 ]. A study of patients with ICI-induced colitis of grade 2 or higher showed that inflammatory changes, such as foci of neutrophilic cryptitis, crypt abscesses, glandular destruction, and erosions of the mucosal surface were diffusely displayed in three quarters of the cases [ 32 ].…”

Section: Pathophysiology Of Ici-induced Colitismentioning

confidence: 99%

“…A study of patients with ICI-induced colitis of grade 2 or higher showed that inflammatory changes, such as foci of neutrophilic cryptitis, crypt abscesses, glandular destruction, and erosions of the mucosal surface were diffusely displayed in three quarters of the cases [ 32 ]. However, there seems to be a lack of correlation between these characteristics and the degree of diarrhea [ 36 , 37 ]. Data on the incidence of chronic colitis are contradictory [ 32 , 34 , 36 , 38 ].…”

Section: Pathophysiology Of Ici-induced Colitismentioning

confidence: 99%

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Checkpoint Inhibitor-Induced Colitis—A Clinical Overview of Incidence, Prognostic Implications and Extension of Current Treatment Options

2021

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In recent years, anti-tumor immunotherapies have witnessed a major breakthrough with the emergence of immune checkpoint inhibitors (ICIs). However, the use of ICIs has also brought an era of a certain class of adverse events that differ from those of classical chemotherapies and are more reminiscent of autoimmune diseases. This article focuses exclusively on colitis as an irAE with emphasis on vulnerable patient groups, the prognostic significance of colitis, treatment, and new therapeutic approaches that may be applicable. Colitis itself is associated with a favorable oncological outcome of the underlying disease but is as well the most common irAE leading to discontinuation of therapy. Especially in vulnerable patient groups such as IBD patients and elderly patients, colitis occurs more frequently as a side effect. It is precisely in these two patient groups that side effects more often lead to discontinuation of therapy. Therefore, in addition to the current therapy of colitis through immunosuppression, the focus should also be on new forms of therapy of severe colitis, such as fecal transplantation or ileostomy creation.

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Section: Pathophysiology Of Ici-induced Colitismentioning

confidence: 99%

Section: Pathophysiology Of Ici-induced Colitismentioning

confidence: 99%

Checkpoint Inhibitor-Induced Colitis—A Clinical Overview of Incidence, Prognostic Implications and Extension of Current Treatment Options

2021

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“…One case series found that of eleven patients referred to their center for diarrhea and concern for IMC, the seven patients with endoscopic evidence of IMC had significantly higher episodes of diarrhea per day (7.7 times vs 3.0 times per day), suggesting that number of bowel movements per day may be a useful tool for screening patients who may have immune-mediated colitis vs other causes of diarrhea[ 48 ]. Another recent case series of eight patients found that on colonoscopy, three had findings predominantly in the right colon[ 41 ], suggesting that a full colonoscopy may be important for endoscopic evaluation and diagnosis of IMC, even though it has previously been suggested that inflammation is typically contiguous beginning in the rectum and therefore flexible sigmoidoscopy would be sufficient for the diagnosis of IMC[ 43 ].…”

Section: Imcmentioning

confidence: 99%

Immune checkpoint inhibitor-mediated colitis in gastrointestinal malignancies and inflammatory bowel disease

Weingarden¹,

Rubin²,

Gubatan³

2021

WJGO

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Immune checkpoint inhibitors (ICI) have markedly changed the landscape of cancer therapy. By re-invigorating the immune system against tumors, ICI provide novel therapeutic options for a broad variety of malignancies, including many gastrointestinal (GI) cancers. However, these therapies can also induce autoimmune-like side effects in healthy tissue across the body. One of the most common of these side effects is ICI-mediated colitis and diarrhea (IMC). Here, we review the incidence and risk of IMC in ICI therapy, with a focus on what is known regarding IMC in patients with GI malignancies. We also discuss data available on the use of ICI and risk of IMC in patients with pre-existing inflammatory bowel disease, as these patients may have increased risk of IMC due to their underlying intestinal pathology.

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“…The recent development of these drugs has revolutionized immunotherapy of malignant tumors. Many malignancies may be treated using ICIs, including melanoma, non‐small cell lung cancer, renal cell carcinoma, Hodgkin lymphoma, squamous cell carcinomas of the head and neck, gastric cancer, and esophageal cancer 1,2 . Additional applications are expected in the future.…”

Section: Introductionmentioning

confidence: 99%

A case of immune checkpoint inhibitor‐associated gastroenteritis detected by ultrasonography

Omotehara

Nishida

Yamanashi

et al. 2021

J of Clinical Ultrasound

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While immune checkpoint inhibitors (ICIs) have antitumor effects, they also have characteristic side effects, including colitis. However, gastritis has rarely been reported. We report a case of a patient with lung adenocarcinoma who presented with epigastric pain and diarrhea following pembrolizumab administration. Sonography of the abdomen demonstrated diffuse, although mild, gastric wall thickening (mainly in the submucosa), as well as a slight decrease in echogenicity throughout the gastric wall. While the mucosal surface was relatively smooth, color Doppler examination showed increased vascularity. Esophagogastroduodenoscopy and pathological examination confirmed the diagnosis of ICI‐related gastroenteritis.

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Clinical, Endoscopic, and Pathological Characteristics of Immune Checkpoint Inhibitor-Induced Gastroenterocolitis

Cited by 28 publications

References 11 publications

Checkpoint Inhibitor-Induced Colitis—A Clinical Overview of Incidence, Prognostic Implications and Extension of Current Treatment Options

Checkpoint Inhibitor-Induced Colitis—A Clinical Overview of Incidence, Prognostic Implications and Extension of Current Treatment Options

Immune checkpoint inhibitor-mediated colitis in gastrointestinal malignancies and inflammatory bowel disease

A case of immune checkpoint inhibitor‐associated gastroenteritis detected by ultrasonography

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