Association of Celiac Disease With Pembrolizumab

Sethi, Ashish; Helfand, Alexander M.; Balikani, Lamé; Bunker, Mark; Finley, Gene Grant

doi:10.7759/cureus.15565

Cited by 6 publications

(9 citation statements)

References 15 publications

(17 reference statements)

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“…Sethi et al described the case of a 63-year-old Caucasian female diagnosed with metastatic adenocarcinoma of unknown primary origin, treated with a combination of carboplatin, paclitaxel, and pembrolizumab (10). The patient presented with diarrhea without blood, mild diffuse abdomen pain, and weight loss after starting pembrolizumab.…”

Section: Discussionmentioning

confidence: 99%

Celiac Disease After Administration of Immune Checkpoint Inhibitors: A Case Report

et al. 2021

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Immune checkpoint inhibitors (ICI) reinvigorate the immune system to recognize and destroy tumor cells. Because of this biological mechanism, patients might develop autoimmune toxicities, notably in the digestive tract (most frequently, hepatitis or colitis). A 70-year-old man with relapsed mesothelioma was treated with nivolumab in 3rd line. He was hospitalized for watery and foul-smelling diarrhea. He underwent gastrointestinal endoscopy, showing duodenitis and villous atrophy and measurement of serum IgA antibodies to tissue transglutaminase (tTG-IgA+), leading to the diagnosis of ICI-induced celiac disease. He was treated with steroids, proton pump inhibitors, and a gluten-free diet. If ICI-induced celiac disease is rare in the literature, increasing reports suggest that celiac disease might represent an underestimated ICI toxicity. This case highlights the necessity of complementary investigation (including tTG-IgA and endoscopic biopsies) in patients with atypical digestive symptoms during immunotherapy.

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Section: Discussionmentioning

confidence: 99%

Celiac Disease After Administration of Immune Checkpoint Inhibitors: A Case Report

et al. 2021

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“…These data are summarized in Table 1. Regarding CD patients, a genetic evaluation for DQ2 and DQ8 was reported only in one case [50], EMA was tested in two cases [50,57], TTGA IgA class in ten cases [33,50,53,55,56], and TTGA of IgG class in one case [57] (Table 1). ICIs-CD: celiac disease arising during therapy with immune checkpoint inhibitors; NR: not reported; TTGA: tansglutaminase antibodies; EMA: antiendomysial antibodies; IELs: intraepithelial lymphocytes/100 enterocytes; CD: celiac disease; GI: gastrointestinal; GFD: gluten-free diet.…”

Section: Resultsmentioning

confidence: 99%

“…Based on our predefined inclusion criteria, the literature search identified ten papers in the period 2013–2021. While two of them were original papers, the remaining ones were either case reports or letters to the editor [ 33 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ]. Overall, twenty-five patients were described in these publications with eleven of them receiving a diagnosis of CD confirmed by serological and histological assessment.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Concerning ICIs-CD, since 2013, only eleven cases have been reported with histological documentation in the literature [ 33 , 53 , 55 , 56 , 57 ]. The serological data reported are often incomplete.…”

Section: Discussionmentioning

confidence: 99%

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Histological Features of Celiac-Disease-like Conditions Related to Immune Checkpoint Inhibitors Therapy: A Signal to Keep in Mind for Pathologists

et al. 2022

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Immune checkpoint inhibitors (ICIs) targeting cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), programmed cell death protein (PD-1), and its ligand PDL-1, are finding increasing application in the treatment of malignant neoplasms. The widespread clinical use of these drugs, however, resulted in the discovery of side effects. The occurrence of celiac disease (CD) after ICIs therapy has been reported in the literature, but its incidence remains unknown and the role of ICIs in its onset is not yet clear. In this review, we examine the published data on this topic in order to better understand and define this entity from a histological point of view. We performed an electronic literature search to identify original reports in which CD or pathological CD-like conditions were documented histologically in patients treated with ICIs. We identified ten papers. A total of twenty-five patients were included in these publications, eleven of them receiving a serologic and histological diagnosis of CD, and four a histological diagnosis of CD-like conditions, in which pathogenesis appears to be multifactorial. ICIs can cause a CD-like enteropathy and biopsies with clinical integration are crucial to diagnose this condition. CD rarely has been observed during treatment with ICIs and its morphological aspects are similar to ICIs-CD enteropathy. Moreover, the onset of ICIs-CD may have a distinct immune mechanism compared to classical CD. Thus, the pathologists must make a histological diagnosis of CD with caution and only in adequate clinical and serological context.

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Subclinical Celiac Disease Unmasked by Immune Checkpoint Inhibitor Therapy

Braun¹,

Patel²,

Schwartz³

2023

Journal of Immunotherapy

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Immune checkpoint inhibitors (ICI) are antibodies that block immune checkpoint proteins from binding with their partner proteins on cancer cells, subsequently allowing cytotoxic T-cell-associated enhancement of antitumor responses. Although ICIs have become the standard of care for various malignancies, their use is often limited by unique immune-related adverse events, including dermatologic, endocrine, inflammatory, hepatic, and gastrointestinal events. Diarrhea and colitis are common lower gastrointestinal tract immune-related adverse events, however, only a few cases have reported the association between celiac disease (CD) and ICIs. We report here a case of a 75-year-old man with new onset CD after exposure to the cytotoxic T-lymphocyte-associated antigen-4 ICI, ipilimumab. Although ICI-induced CD is relatively rare, it is essential to consider it in a genetically susceptible patient undergoing treatment with ICI. Patients with known high susceptibility to CD, such as a family history of CD, or with the ancestry of high celiac penetrance (eg, Northern Europe, North Africa, etc), dermatitis herpetiformis, or chronic bowel symptoms, we feel should have celiac panel testing before initiating ICI therapy.

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Association of Celiac Disease With Pembrolizumab

Cited by 6 publications

References 15 publications

Celiac Disease After Administration of Immune Checkpoint Inhibitors: A Case Report

Celiac Disease After Administration of Immune Checkpoint Inhibitors: A Case Report

Histological Features of Celiac-Disease-like Conditions Related to Immune Checkpoint Inhibitors Therapy: A Signal to Keep in Mind for Pathologists

Subclinical Celiac Disease Unmasked by Immune Checkpoint Inhibitor Therapy

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