Systematic review: colitis associated with anti‐<scp>CTLA</scp>‐4 therapy

Gupta, Arjun; Felice, Kara M. De; Loftus, Edward V.; Khanna, Sahil

doi:10.1111/apt.13281

Cited by 249 publications

(265 citation statements)

References 63 publications

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“…About one-third of patients treated with anti-CTLA-4 have irAEs of the gastrointestinal tract, including aphthous ulcers, esophagitis, gastritis, diarrhoea, and colitis. The frequency of colitis ranges from 8% to 22% [7]. In a large study including 676 patients, diarrhoea of any grade occurred in 27–31% of patients receiving ipilimumab [8].…”

Section: Epidemiologymentioning

confidence: 99%

“…It is not completely understood whether the effect on the frequency and severity of irAEs is dose dependent. A phase II trial demonstrated an association between the incidence and severity of irAEs and increasing ipilimumab dose [7]. …”

Section: Epidemiologymentioning

confidence: 99%

“…Diarrhoea and colitis, including severe forms, occur earlier and are more frequent with combined anti-CTLA-4 and anti-PD-1 agents than with either ipilimumab or anti-PD-1 [13]. Other presenting symptoms are abdominal pain, haematochezia, weight loss, fever, and vomiting [1, 7, 13]. Anti-CTLA-4-induced enterocolitis may be associated with mouth ulcers, anal lesions (fistulas, abscesses, fissures), and extra-intestinal manifestations [14].…”

Section: Clinical Featuresmentioning

confidence: 99%

“…Onset of gastrointestinal symptoms may occur at any time during 1–10 infusions of anti-CTLA-4 [1, 7]. Colitis may even occur several months after the last dose of ipilimumab, because the molecular effects on CTLA-4 inhibition may persist longer after clearance of the drug [7].…”

Section: Clinical Featuresmentioning

confidence: 99%

“…Endoscopic findings can include oedema, erythema, loss of vascular pattern, erosions, and ulceration [1, 3, 5, 14]. In a systematic review of colitis associated with anti-CTLA-4 therapy, colonoscopy revealed diffuse inflammatory changes such as exudates, granularity, loss of vascular pattern, and ulcerations [7]. …”

Section: Diagnosismentioning

confidence: 99%

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Management of Gastrointestinal Toxicity from Immune Checkpoint Inhibitor

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et al. 2018

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Immune checkpoint inhibitors have shown anti-tumour activity in cancers such as melanoma, renal cell carcinoma, non-small-cell lung cancer, urothelial carcinoma, colorectal cancer, and Hodgkin’s lymphoma. Though immune checkpoint inhibitors have revolutionized the treatment and prognosis of some advanced malignancies, they are also associated with a significant risk of immune-related adverse events. These adverse events can occur in any organ system, but gastrointestinal side effects are among the most commonly reported, with manifestations ranging from mild diarrhoea to severe colitis, sharing some features with inflammatory bowel disease. Anticipating a greater use of these drugs in the future, gastroenterologists should expect to be increasingly faced with gastrointestinal immune-related adverse events. Knowledge of these toxicities, as well as effective management algorithms, is essential to enable early diagnosis and treatment, decreasing morbidity and mortality. We reviewed the currently available literature on gastrointestinal toxicity induced by immune checkpoint inhibitors, namely the clinical features, diagnosis, and management.

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Section: Epidemiologymentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

Section: Clinical Featuresmentioning

confidence: 99%

Section: Clinical Featuresmentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

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Abdominal Pain and Bloody Diarrhea

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Immuno-oncology for surgeons

Lee

Al‐Shamkhani

Mirnezami

2019

British Journal of Surgery

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Cancer has traditionally been treated with surgery, cytotoxic chemotherapy and/or radiotherapy. The focus of treatment has been the mutated neoplastic cell. Critical advances in genomic and molecular techniques herald the potential for personalized treatments. Incremental breakthroughs in immunology have translated to a step‐change in care by providing a mechanistic understanding of the immune system and how it may be mobilized to target cancer cells. As a result, clinical trials of immune‐modifying agents have increased at an exponential rate and are revolutionizing cancer care. It is increasingly likely that the surgical oncologist will find themself caring for patients who have had immuno‐oncology therapies as part of their neoadjuvant or adjuvant treatment. This review provides an update on immuno‐oncology for the surgeon, covering the mechanisms of action of the agents in use. Emerging and surgically relevant toxicities are discussed, and available data on combining and sequencing cancer surgery with immuno‐oncology treatments are summarized.

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Systematic review: colitis associated with anti‐CTLA‐4 therapy

Cited by 249 publications

References 63 publications

Management of Gastrointestinal Toxicity from Immune Checkpoint Inhibitor

Management of Gastrointestinal Toxicity from Immune Checkpoint Inhibitor

Abdominal Pain and Bloody Diarrhea

Immuno-oncology for surgeons

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