Immune checkpoint inhibitor-induced colitis: A comprehensive review

Som, Aniruddh; Mandaliya, Rohan; Alsaadi, Dana; Farshidpour, Maham; Charabaty, Aline; Malhotra, Nidhi; Mattar, Mark

doi:10.12998/wjcc.v7.i4.405

Cited by 202 publications

(231 citation statements)

References 83 publications

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“…Immunotherapy using immune checkpoint inhibitors (ICIs), which can interrupt the cancer-immunity cycle and promote the tumor-specific immune cell activity without intrinsic cytotoxicity, has become the standard of care for a variety of tumors, including melanoma, lung cancer, urothelial cancer, kidney cancer, and hepatocellular carcinoma (HCC) [1][2][3][4][5][6][7][8][9][10][11][12]. For HCC patients, increasing importance has been attached to liver transplantation (LT) thanks to the advances in surgical techniques and immunosuppression regimens, resulting in the mean 1-year and 5-year survival rates of 85-90% and 70-75%, respectively [13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Liver graft rejection following immune checkpoint inhibitors treatment: a review

Yang

Sang

2019

Med Oncol

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Immune checkpoint inhibitors (ICIs) have demonstrated remarkable efficacy in a variety of solid tumors; nonetheless, they have not been well investigated and are still recognized as a relative contraindication for patients with a liver transplantation (LT) history, since ICIs treatment might potentially lead to graft rejection. The program death-1 (PD-1) and the cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) pathways are implicated in the tolerance of transplanted organ, as well as blockade of the pathways, which contribute to eliminating tumors and may inadvertently lead to peripheral transplant rejection. Currently, no guidelines are available regarding the treatment for ICIs patients with a prior LT history. Therefore, this study was carried out to review the recent studies, attempting to introduce the ICIs-related graft rejection after LT from various aspects. We believed that ICIs could be given for the well-informed patients receiving LT and developed recurrence in a controlled setting. Typically, these patients should be treated according to a clinical care path or a prospective clinical trial, so as obtain a persistent anti-tumor immune response in the meantime of avoiding graft rejection, adjust the immunosuppression, reduce the possibility of graft loss following rejection, and have the opportunity to develop biomarkers for tumor response and transplant rejection.

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Section: Introductionmentioning

confidence: 99%

Liver graft rejection following immune checkpoint inhibitors treatment: a review

Yang

Sang

2019

Med Oncol

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“…nivolumab) have a risk of 1.3%-2.9%. Other classes of ICPIs such as anti-CTLA-4 and anti-PD-L1 showed a risk of 7.0%-11.6% and 0.7%-19.7% [4]. When comparing anti-PD-1 inhibitors to the other class of ICPIs, the frequency and severity of colitis seem to be lower.…”

Section: Discussionmentioning

confidence: 91%

“…The Common Terminology Criteria for Adverse Events (CTCAE) are a set of criteria used to classify the adverse effects of drugs in clinical trials including cancer therapy. Based on the CTCAE grading (severity) scale, the treatment options may vary from the symptomatic treatment of diarrhea with loperamide and electrolyte repletion to the initiation of immunosuppressive agents [4]. In the case of refractory colitis, multiple studies have shown a response to infliximab, mycophenolate, cyclosporine, and Entyvio [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

A Case of Immune Checkpoint Inhibitor Refractory Colitis Treated with Mycophenolate and High-dose Steroids

Alcantar

Al-Jaashaami

Giron

2019

Cureus

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Immune checkpoint inhibitors (ICPI) are a class of chemotherapy agents that have emerged as a front-line treatment option for multiple cancers. Nivolumab is an ICPI agent commonly used to treat metastatic melanoma. Although promising, the adverse reaction of this class is broad and per reports, the incidence of colitis is <6%. We present the case of a 71-year-old male with a history of metastatic melanoma who was being treated with nivolumab. The patient was two weeks into his treatment regimen when he began complaining of multiple loose, bloody stools. Because of these symptoms, his nivolumab was discontinued. However, despite discontinuation, his symptoms persisted and the patient underwent a colonoscopy. He was found to have diffuse inflammation of the colon and was diagnosed with nivolumab-induced colitis. Subsequently, the patient underwent multiple treatments, including high-dose steroids, infliximab, and vedolizumab (Entyvio), with no resolution of symptoms. After several months of failed treatment, the patient was readmitted to the hospital for refractory colitis. He was started on high-dose steroids and underwent a repeat colonoscopy, which again showed diffuse colitis. Because of the previously failed treatment options, mycophenolate, an immunosuppressant, was initiated in combination with his steroids. After three days of high-dose steroids and mycophenolate, the patient's symptoms resolved, with no subsequent apparent symptoms of colitis. We present a case of nivolumab-induced colitis, refractory to multiple immunosuppressive medications, which was successfully treated with mycophenolate and high-dose steroids.

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“…Immunassoziierte Kolitidenund Diarrhöensind häufigeirAEs und treten später, meist etwa 5 bis 10 Wochen nach der zweiten oder dritten ICI-Gabe, als dermatologische irAEs auf [15]. Abb.…”

Section: Gastrointestinale Manifestationunclassified

Nebenwirkungen neuer onkologischer Immuntherapien

et al. 2020

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Zusammenfassung Online teilnehmen unter: www.springermedizin.de/cme Für diese Fortbildungseinheit werden 3 Punkte vergeben. Kontakt Springer Medizin Kundenservice Tel. 0800 77 80 777 (kostenfrei in Deutschland) E-Mail: kundenservice@springermedizin.de Informationen zur Teilnahme und Zertifizierung finden Sie im CME-Fragebogen am Ende des Beitrags.Systemtherapien mit Immun-Checkpoint-Inhibitoren (ICI) haben in den letzten Jahren die Behandlung onkologischer und hämatologischer Erkrankungen revolutioniert. Ihre Wirkung besteht in einer Steigerung der Aktivität des körpereigenen Immunsystems zur Tumorelimination. Als relevante, zugelassene Substanzen spielen insbesondere PD-1-, PD-L1-und CTLA-4-Inhibitoren eine Rolle. Hierdurch findet ein Wandel des Nebenwirkungsspektrums weg von klassischen Zytostatikaeffekten wie Panzytopenie oder Polyneuropathie hin zu bislang ungewöhnlichen immunvermittelten komplexen Krankheitsbildern statt. Diese sogenannten "immune-related adverse events" (irAEs) können sämtliche Organsysteme befallen und klassische Autoimmunerkrankungen widerspiegeln. Sie zu erkennen und zügig einer passenden Therapie zuzuführen, stellt eine Herausforderung im klinischen Alltag dar und bedarf eines intensiven interdisziplinären Managements. Gerade Nephrologen sind als intensiv interdisziplinär tätige Internisten hierbei gefragt. Der vorliegende CME-Artikel soll das gesamte Spektrum sowohl der selteneren renalen als auch der häufigeren nicht-renalen immunvermittelten Nebenwirkungen darstellen und auf deren Diagnostik und Therapie vorbereiten. SchlüsselwörterSpektrum immunvermittelter Nebenwirkungen (irAEs) · irAE-Diagnostik · Immun-Checkpoint-Inhibitoren · Immune-related adverse events (irAEs) · Interdisziplinäres irAE-Management Der Nephrologe 3 · 2020 191 CME Lernziele Der vorliegende CME-Artikel soll das gesamte Spektrum immunvermittelter Nebenwirkungen darstellen und dabei auf deren Diagnostik und Therapie vorbereiten. Neben seltenen Nierenbeteiligungen wird insbesondere auf die häufigeren nichtrenalen immunvermittelten Nebenwirkungen eingegangen. Nach Absolvieren dieser Fortbildungseinheit können Sie ... -Wirkungsweise und Anwendungsbereich der Checkpoint-Inhibitoren erklären. -Spektrum und Häufigkeit von immunvermittelten Nebenwirkungen benennen. schwerwiegende immunvermittelte Nebenwirkungen erkennen. -Monitoring und Diagnostik auf immunvermittelte Nebenwirkungen durchführen. therapeutische Maßnahmen bei immunvermittelten Nebenwirkungen einleiten.

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Immune checkpoint inhibitor-induced colitis: A comprehensive review

Cited by 202 publications

References 83 publications

Liver graft rejection following immune checkpoint inhibitors treatment: a review

Liver graft rejection following immune checkpoint inhibitors treatment: a review

A Case of Immune Checkpoint Inhibitor Refractory Colitis Treated with Mycophenolate and High-dose Steroids

Nebenwirkungen neuer onkologischer Immuntherapien

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