Endoscopic findings of checkpoint inhibitor–induced ileitis with use of the latest advanced endoscopic optical diagnosis: near-focus narrow-band imaging

Smith, Samuel C.; Zardo, Davide; Cannatelli, Rosanna; Stevens, Neil C.; Iacucci, Marietta

doi:10.1016/j.vgie.2018.11.005

Cited by 6 publications

(3 citation statements)

References 5 publications

(8 reference statements)

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“…Colitis shares some of the features of Crohn's disease and the small bowel may be involved (with lymphocytic and neutrophilic inflammation and in some cases granuloma and crypt abscesses). 24 Recently, attention has focused on delayed immune-related events (DIREs) after discontinuation of immunotherapy, but these appear uncommon for GI toxicity and more common for endocrine, dermatologic or neurologic toxicities. 25 Table 2.…”

Section: Pathogenesismentioning

confidence: 99%

Immune checkpoint inhibitor-associated gastrointestinal and hepatic adverse events and their management

Shivaji

Jeffery

Gui

et al. 2019

Therap Adv Gastroenterol

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Background: Drug-induced colitis is a known complication of therapies that alter the immune balance, damage the intestinal barrier or disturb intestinal microbiota. Immune checkpoint inhibitors (ICI) directed against cancer cells may result in activated T lymphocyte-induced immune-related adverse events (AEs), including immune-related colitis and hepatitis. The aim of this review article is to summarize the incidence of gastrointestinal (GI) and hepatic AEs related to ICI therapy. We have also looked at the pathogenesis of immune-mediated AEs and propose management strategies based on current available evidence. Methods: A literature search using PubMed and Medline databases was undertaken using relevant search terms pertaining to names of individual drugs, mechanism of action, related AEs and their management. Results: ICI-related GI AEs are common, and colitis appears to be the most common side effect, with some studies reporting incidence as high as 30%. The incidence of both all-grade colitis and hepatitis were highest with combination therapy with anti-CTLA-4/PD-1; severity of colitis was dose-dependent (anti-CTLA-4). Early intervention is associated with better outcomes. Conclusion: ICI-related GI and hepatic AEs are common and clinicians need to be aware. Patients with GI AEs benefit from early diagnosis using endoscopy and computed tomography. Early intervention with oral steroids is effective in the majority of patients, and in steroid-refractory colitis infliximab and vedolizumab have been reported to be useful; mycophenolate has been used for steroid-refractory hepatitis.

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Section: Pathogenesismentioning

confidence: 99%

Immune checkpoint inhibitor-associated gastrointestinal and hepatic adverse events and their management

Shivaji

Jeffery

Gui

et al. 2019

Therap Adv Gastroenterol

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“…In recent years, the use of immunotherapy could also be successful in some refractory cases. These are particular and challenging patients due to the immune stimulation that could cause immune-related colitis similar to IBD as clinical symptoms, endoscopic appearance, and pathological infiltrate, with minor changes [65]. In particular, patients under anti-cytotoxic T lymphocyte antigen, such as ipilimumab, or antiprogrammed death-1, such as nivolumab, pembrolizumab, and atezolizumab, have been found linked to the development of IBD-like colitis, more common in patients under more than one therapy.…”

Section: Risk Of Ibd Relapse In Patients With Cancer Who Discontinue ...mentioning

confidence: 99%

Therapeutic Management of Adults with Inflammatory Bowel Disease and Malignancies: A Clinical Challenge

Ferretti

Cannatelli

Maconi

et al. 2023

Cancers

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Patients with chronic inflammatory bowel diseases (IBD) have increased risk of developing intestinal and extraintestinal cancers. However, once a diagnosis of malignancy is made, the therapeutic management of Crohn’s disease (CD) and ulcerative colitis (UC) can be challenging as major guidelines suggest discontinuing the ongoing immunosuppressant and biological therapies for at least 2–5 years after the end of cancer treatment. Recently, new molecules such as vedolizumab and ustekinumab have been approved for IBD and limited data exist on the real risk of new or recurrent cancer in IBD patients with prior cancer, exposed to immunosuppressants and biologic agents. Thus, a multidisciplinary approach and case-by-case management is the preferred choice. The primary aim of our review was to summarize the current evidence about the safety of reintroducing an immunosuppressant or biologic agent in patients with a history of malignancy and to compare the different available therapies, including gut-selective agents. The secondary aim was to evaluate the clinical course of the IBD patients under cancer treatment who do not receive any specific immunosuppressant treatment after the diagnosis of cancer.

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“…In 10 reports (Table 1), VA was present and developed during therapy with PD/ PD-L1 inhibitors for solid tumours. [16][17][18][19][20][21][22][23][24][25] In the remaining 9 (Table 2), patients developed small bowel involvement other than VA. [26][27][28][29][30][31][32][33][34] Finally, we identified 2 single-centre retrospective case series reporting cases of small bowel involvement. In the first, 2 cases of enteropathy with VA are described and, in the second, 8 cases of coeliac disease associated with ICIs and a further 9 cases of VA related to ICIs with negative tissue transglutaminase antibodies are reported.…”

Section: Reviewmentioning

confidence: 99%

Small bowel villous atrophy due to immune-checkpoint inhibitors: report of two cases and literature review

Schiepatti¹,

Premoli²,

Maimaris³

et al. 2022

DIC

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Endoscopic findings of checkpoint inhibitor–induced ileitis with use of the latest advanced endoscopic optical diagnosis: near-focus narrow-band imaging

Cited by 6 publications

References 5 publications

Immune checkpoint inhibitor-associated gastrointestinal and hepatic adverse events and their management

Immune checkpoint inhibitor-associated gastrointestinal and hepatic adverse events and their management

Therapeutic Management of Adults with Inflammatory Bowel Disease and Malignancies: A Clinical Challenge

Small bowel villous atrophy due to immune-checkpoint inhibitors: report of two cases and literature review

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