Cetuximab-Associated Pneumatosis Intestinalis

Sherman, Ester; Ramadas, Poornima; Lemke, Sheila

doi:10.1097/mjt.0000000000000811

Cited by 6 publications

(4 citation statements)

References 2 publications

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“…125 Antibodies against the anti-epidermal growth factor (EGFR) include cetuximab and panitumumab are increasingly utilised in nonsmall cell lung cancer and colon cancer. Several case reports link cetuximab use to SB injury, including pneumatosis intestinalis 126,127 and ileal peforation. 128,129 This association with SB injury has been emphasised in a meta-analysis study by Miroddi et al including 18 clinical trials enrolling 13 958 patients which found an association with diarrhoea (grade 3-4) (RR 1.66, CI: 1.52-1.80) and mucositis (RR 3.44, CI: 2.66-4.44).…”

Section: Monoclonal Antibodies (Immunotherapy)mentioning

confidence: 99%

Review article: drug‐induced small bowel injury

Hamdeh

Micic

Hanauer

2021

Aliment Pharmacol Ther

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Background: Drug-induced gastrointestinal injury has been increasingly reported, but its exact incidence is not known. The small and large intestines represent the most affected sites of injury, accounting for 20%-40% of all gastrointestinal side effects. Aim:To provide an updated literature review detailing medications linked to the development of small bowel injury. Methods:We conducted a literature search on PubMed from its inception to May 1, 2021. We included English-language original studies, meta-analyses, systematic reviews, review articles and case reports.Results: Drug-induced enteropathy can range from asymptomatic histological changes resulting in a subtle, self-limited disease to a chronic inflammatory condition mimicking inflammatory bowel disease, or bowel perforation. Endoscopy can demonstrate erythema, mucosal friability, oedema, erosions, ulcers or strictures in severe cases. Histology may include mucosal erosions and ulcerations, focal active enteritis, villous atrophy, epithelial apoptosis or necrotising enteritis. A well-established association has been found with the use of nonsteroidal anti-inflammatory drugs, immunosuppressants, chemotherapeutic agents, antibiotics, immunotherapies, etanercept and olmesartan. Possible associations have been reported with other biologic agents, medications used for glycemic control, antihypertensives, cholinesterase inhibitors, potassium and iron supplements, with conflicting data regarding contraceptives/hormonal therapy and isotretinoin. Conclusion:Physicians should be aware of the manifestations of drug-induced enteropathy as early recognition can lead to prompt discontinuation of the offending therapy and, therefore, a reduced risk of future complications.

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Section: Monoclonal Antibodies (Immunotherapy)mentioning

confidence: 99%

Review article: drug‐induced small bowel injury

Hamdeh

Micic

Hanauer

2021

Aliment Pharmacol Ther

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“…All titles were screened, after which 65 full-text articles were assessed for eligibility. Ultimately, 50 records that met our eligibility criteria were identified, and 12 more reports were retrieved through reference mining, reaching a total of 62 articles that were included in our systematic review ( Figure 2 ) [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 62 , 64 , 65 , 67 , 68 , 69 , ...…”

Section: Resultsmentioning

confidence: 99%

“…Among adult patients, secondary PI is mainly associated with gastrointestinal disease, pulmonary diseases, mechanical ventilation, endoscopic procedures, infections and other immunological conditions [ 8 ]. Medications used for cancer treatment are among the most recognized causes of PI, including cytotoxic chemotherapeutic agents [ 9 ] and molecular targeted agents [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ].…”

Section: Introductionmentioning

confidence: 99%

Pneumatosis Intestinalis Induced by Anticancer Treatment: A Systematic Review

Gazzaniga

Villa

Tosi

et al. 2022

Cancers

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Pneumatosis intestinalis (PI) is a rare condition due to the presence of gas within the bowel wall; it is mainly caused by endoscopic procedures, infections and other gastrointestinal diseases. Oncological therapies have been reported to be a cause of PI as well, but their role is not clearly defined. This systematic review investigates the concurrency of PI and antitumor therapy in cancer patients, considering both solid tumors and onco-hematological ones. We performed a literature review of PubMed, Embase and the Web of Science up to September 2021 according to the PRISMA guidelines. A total of 62 papers reporting 88 different episodes were included. PI was mainly reported with targeted therapies (sunitinib and bevacizumab above all) within the first 12 weeks of treatment. This adverse event mostly occurred in the metastatic setting, but in 10 cases, it also occurred also in the neoadjuvant and adjuvant setting. PI was mostly localized in the large intestine, being fatal in 11 cases, while in the remaining cases, symptoms were usually mild, or even absent. A significant risk of PI reoccurrence after drug reintroduction was also reported (6/18 patients), with no fatal outcomes. Potential pharmacological mechanisms underlying PI pathogenesis are also discussed. In conclusion, although uncommonly, PI can occur during oncological therapies and may lead to life-threatening complications; therefore, consideration of its occurrence among other adverse events is warranted in the presence of clinical suspicion.

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“… 55 As demonstrated in a meta-analysis of 18 clinical trials with anti-EGFR therapy, the incidences of severe diarrhea (grade 3–4) and mucositis/stomatitis were 18% and 8% (compared with the control arm of 11% and 2%), respectively. 56 Some cases reported other rare GI symptoms, including pneumatosis intestinalis and ileal perforation 57 – 60 and GI hemorrhage 61 with endoscopic evidence of severe mucosa congestion and erosion.…”

Section: Egfr Inhibitorsmentioning

confidence: 99%

Gastrointestinal injury induced by immunomodulators: A review article

Zhang

Mao

Zhang

et al. 2023

Therap Adv Gastroenterol

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An increasing number of immunomodulators, either anti-inflammatory or immunity-enhancing, have brought about a revolutionary effect in the management of a variety of autoimmune disorders and malignancies. However, their ability to cause gastrointestinal (GI) injury and induce GI symptoms has been increasingly and unexpectedly recognized. GI injury associated with immunomodulators may demonstrate various histologic and endoscopic patterns. Optimal diagnosis and treatment require a multidisciplinary approach. This review aims to provide an overview of the literature on its pathogenesis, the clinical, endoscopic, and histologic features, and suggested approaches to manage these newly recognized immunomodulator-induced GI adverse effects (AEs). We also reviewed current biomarkers predictive of GI toxicity and potential risk factors to identify susceptible patients. In addition, these immune-mediated AEs were compared with inflammatory bowel disease, a well-documented form of inflammation-driven GI injury. We hope this review will raise awareness and vigilance among clinicians of these entities to increase early diagnosis and rapid referral to specialist care.

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Cetuximab-Associated Pneumatosis Intestinalis

Cited by 6 publications

References 2 publications

Review article: drug‐induced small bowel injury

Review article: drug‐induced small bowel injury

Pneumatosis Intestinalis Induced by Anticancer Treatment: A Systematic Review

Gastrointestinal injury induced by immunomodulators: A review article

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