Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management of severe gastrointestinal and hepatic toxicities from checkpoint inhibitors

Dougan, Michael; Blidner, Ada G.; Choi, Jennifer N.; Cooksley, Tim; Glezerman, Ilya G.; Ginex, Pamela; Girotra, Monica; Gupta, Dhiraj; Johnson, Douglas B.; Shannon, Vickie R.; Suarez‐Almazor, María E.; Anderson, Ronald; Rapoport, Bernardo Leon

doi:10.1007/s00520-020-05707-3

Cited by 34 publications

(31 citation statements)

References 81 publications

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“…Several general or organ-specific recommendations have been published to help to manage irAEs [ 17 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ]. Generally, ICI should be continued with close monitoring for grade 1 irAEs, except for some neurologic, hematologic, and cardiac toxicities.…”

Section: Unmet Medical Needsmentioning

confidence: 99%

Safety of Immune Checkpoint Inhibitor Resumption after Interruption for Immune-Related Adverse Events, a Narrative Review

Allouchery

Beuvon

Pérault‐Pochat

et al. 2022

Cancers

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Immune checkpoint inhibitors (ICIs) have become the standard of care for several types of cancer due to their superiority in terms of survival benefits in first- and second-line treatments compared to conventional therapies, and they present a better safety profile (lower absolute number of grade 1–5 adverse events), especially if used in monotherapy. However, the pattern of ICI-related adverse events is totally different, as they are characterized by the development of specific immune-related adverse events (irAEs) that are unique in terms of the organs involved, onset patterns, and severity. The decision to resume ICI treatment after its interruption due to irAEs is challenged by the need for tumor control versus the risk of occurrence of the same or different irAEs. Studies that specifically assess this point remain scarce, heterogenous and mostly based on small samples of patients or focused only on the recurrence rate of the same irAE after ICI resumption. Moreover, patients with grade ≥3 irAEs were excluded from many of these studies. Herein, we provide a narrative review on the field of safety of ICI resumption after interruption due to irAE(s).

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Section: Unmet Medical Needsmentioning

confidence: 99%

Safety of Immune Checkpoint Inhibitor Resumption after Interruption for Immune-Related Adverse Events, a Narrative Review

Allouchery

Beuvon

Pérault‐Pochat

et al. 2022

Cancers

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“…2 In contrast to EGE, conventional gastroenteritis associated with ICI often requires high-dose oral prednisolone (1-2 mg/kg) and sometimes demands infliximab or vedolizumab to treat. 4,5 Thus, it is important to distinguish between EGE and conventional gastroenteritis when considering treatment.…”

Section: Eosinophilic Gastroenteritis In a Melanoma Patient Treated With Nivolumabmentioning

confidence: 99%

Eosinophilic gastroenteritis in a melanoma patient treated with nivolumab

Tomiyasu

Komori

Ishida

et al. 2021

The Journal of Dermatology

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“…While fecal calprotectin can be used as a noninvasive marker for the presence of inflammation, 17 GI consult is recommended for endoscopic evaluation in patients with grade 2 diarrhea or evidence of colitis 17 as early endoscopic assessment has been suggested to be associated with better clinical course and shorter treatment. 94,95 If grade 2 diarrhea persists for > 3 days, treatment with prednisone at a dose of 1 mg/kg daily should be initiated with the goal of tapering by 5 to 10 mg weekly over 4 to 6 weeks. 92 Steroid resistant patients should receive biological therapy.…”

Section: Managementmentioning

confidence: 99%

“…The presence of ulceration in the colonic mucosa is a predictor of resistance to first-line treatment with CSs and a more complicated clinical course. 57,94 Patients who undergo endoscopic exam can be stratified into risk groups: low (normal endoscopic/histologic features), moderate (normal-appearing mucosa with histologic evidence of inflammation, nonulcer inflammatory changes, small <1 cm or shallow <2 mm ulcerations) and severe (large and/or deep ulcers, extensive inflammation beyond the left colon). 17 Patients with low-risk features on their initial endoscopic exams, will usually need one dose of a biologic if they are CS refractory.…”

Section: Managementmentioning

confidence: 99%

“…17 About 30% to 40% of patients who require CSs therapy will be resistant to therapy and require treatment with IFX or VDZ. 94,96,97 There are no data to help clinicians choose between IFX and VDZ for CS refractory patients, but as a general rule, IFX should be avoided in patients with confirmed or suspected infections or other contraindications to tumor necrosis factor alpha inhibitors, while caution is advised when considering VDZ in patients with GI tract cancers or metastasis or GI tract infections. 44 Biologics usually work rapidly, with responses seen in less than a week.…”

Section: Managementmentioning

confidence: 99%

See 1 more Smart Citation

Immunotherapy-induced Colitis

Vaziri¹,

Turshudzhyan

Vecchio³

2022

Journal of Clinical Gastroenterology

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Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of a variety of malignancies including advanced melanoma, non-small cell lung cancer, renal cell carcinoma, head and neck cancers among others. Since their introduction, there has been significant improvement in survival and prognosis in patients with advanced malignancies. Unfortunately, improved outcomes have come at a price of significant immune-related adverse events, with those of the gastrointestinal tract being the most common. Gastrointestinal immune-related adverse events frequently present as diarrhea and colitis, the severity of which can range from mild diarrhea to fulminant colitis with intestinal perforation. Currently, management of ICI-induced colitis is primarily guided by retrospective studies and expert opinion. A significant number of ICIinduced colitis responds to high-dose corticosteroids; however, some patients require further therapy with biologics. There is limited information on the factors which may predispose patients to ICIinduced colitis. Future research elucidating these risk factors along with development of a scoring system could allow for risk-stratification of patients before initiation of ICI therapy. Such a system may help clinicians and patients keep a high index of suspicion regarding ICI-induced colitis and could hopefully reduce the incidence of severe cases. Similarly, future studies should investigate protective factors against ICI-induced colitis, which could potentially allow more patients to safely benefit from ICI therapy.

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Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management of severe gastrointestinal and hepatic toxicities from checkpoint inhibitors

Cited by 34 publications

References 81 publications

Safety of Immune Checkpoint Inhibitor Resumption after Interruption for Immune-Related Adverse Events, a Narrative Review

Safety of Immune Checkpoint Inhibitor Resumption after Interruption for Immune-Related Adverse Events, a Narrative Review

Eosinophilic gastroenteritis in a melanoma patient treated with nivolumab

Immunotherapy-induced Colitis

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