Endoscopic evaluation of immunotherapy-induced gastrointestinal toxicity

Abstract

Immunotherapy is any treatment aimed at boosting or enhancing the immune system. It includes a wide range of options, from vaccines to treatment for conditions such as allergy and cancer. In the case of cancer, unlike other available treatments, immunotherapy is not aimed at destroying the tumor cells but at stimulating the patient’s immune system so that it attacks the tumor. In cancer, immunotherapy provides a series of advantages. Nevertheless, immunotherapy administered for treatment of cancer is associated with immune-mediated enterocolitis. Colitis mediated by monoclonal anti-cytotoxic T lymphocyte–associated antigen 4 and to programmed cell death protein 1 and its ligand PDL1 shares characteristics with chronic inflammatory bowel disease (IBD), and similar findings have been reported for both the endoscopy images and the segment involved. The most frequent lesions on endoscopy are ulcer and erythema, and the most frequently affected site is the sigmoid colon. A segmental pattern has been reported to be slightly more frequent than a continuous pattern. In addition, upper gastrointestinal lesions have been reported in up to half of patients, with the most frequent findings being gastritis and erosive duodenitis. As is the case in IBD, systemic corticosteroids and immunosuppressive treatment (anti-TNF agents) are the approaches used in patients with a more unfavorable progression. Immunotherapy must be suspended completely in some cases.

Severe immune checkpoint inhibitor-associated gastritis: A case series and literature review

“…Furthermore, there were some patients in whom a large amount of whitish purulent discharge covered the mucosal surface, resulting in pseudo-membranous formation. This appearance was described as “fibrin-covered superficial erosions” in a previous report involving endoscopic evaluation of gastrointestinal toxicity 15 16 24 . Finally, the third finding was quite characteristic as well.…”

Acute Liver Failure following a Single Dose of Atezolizumab, as Assessed for Causality Using the Updated RUCAM

“…Immune checkpoint inhibitors (ICI) are antineoplastic agents that activate the immune system against tumor cells. Programmed death 1 (PD-1), its ligand-1 (PD-L1), and cytotoxic T-lymphocyte antigen 4 (CTLA-4) are the most common targets of these agents, which operate by relieving tumor-induced T-cell inactivation [ 1 ]. Atezolizumab is an Fc-modified IgG1 humanized monoclonal antibody directed against PD-L1 [ 2 ].…”

Gut microbiome and checkpoint inhibitor colitis

“…Other lesions usually seen on endoscopy include exudates, granularity and loss of vascular www.irjournal.org pattern, which appear to be similar to those seen in inflammatory bowel disease (ulcerative colitis and Crohn' s disease). 20 In addition to endoscopic findings, histological findings in ICI induced colitis are also similar to inflammatory bowel disease. On histology, intraepithelial neutrophils in the surface epithelium and crypt epithelium are seen in ICI induced colitis similar to inflammatory bowel disease.…”