Immunotherapy for Cancer: Common Gastrointestinal, Liver, and Pancreatic Side Effects and Their Management

Abstract

Cancer cells can block the activation of T lymphocytes by deploying inhibitory signals to cell surface receptors that downregulate the immune response. Immune checkpoint inhibitors (ICI) are monoclonal antibodies that regulate the immune response by acting on these receptors. The use of ICI has been successful for cancer types that do not respond well to conventional chemotherapy, showing clinical benefit in various advanced and metastatic cancers and supporting the promise of cancer immunotherapy. However, in some cases, these treatments are associated with immune-related adverse events, many of which affect the digestive system. The treatment of immune-related adverse events depends on the affected organ and the severity of symptoms. Here, we review the commonly used US FDA-approved ICI and briefly outline their mechanism of action. We also describe the resulting collateral effects on the gastrointestinal tract, liver, and pancreas and discuss their management and prognosis.

The rising roles of exosomes in the tumor microenvironment reprogramming and cancer immunotherapy

“…The significant efficacy of ICIs in the application of solid tumors indicates that immunotherapy has broad development prospects 183 . However, about 46.4% of cancer patients who respond to ICIs develop acquired resistance during treatment 184 .…”

An algorithm based on immunotherapy discontinuation and liver biopsy spares corticosteroids in two thirds of cases of severe checkpoint inhibitor‐induced liver injury

“…4 Checkpoint inhibitor-induced liver injury (ChILI) may occur in 2%-25% patients treated with ICIs. 5 Although this toxicity is normally mild, it can be life-threatening in the case of acute liver failure development. 6,7 As for the rest of severe irAEs, treatment with corticosteroids (CS) is the backbone of therapy for severe ChILI, 8,9 that is grade 3 or grade 4 hepatitis according to the Common Terminology Criteria for Adverse Events (CTCAE) system.…”

“…Checkpoint inhibitor‐induced liver injury (ChILI) may occur in 2%–25% patients treated with ICIs 5 . Although this toxicity is normally mild, it can be life‐threatening in the case of acute liver failure development 6,7 .…”

Aggregation‐induced emission luminogens for in vivo molecular imaging and theranostics in cancer

“…[12,13] Unfortunately, almost all cancers still have no effective treatment to realize a complete cure, and most the cancer therapies have nonnegligible side effects affecting the biological functions of normal tissues and organs. [14][15][16] Real-time molecular imaging-based evaluation of cancer therapy is essential to precisely learn about the whole process of cancer treatment.…”

“…Organic dyes have displayed great potential and become promising candidates for in vivo cancer imaging and theranostics. [16,[20][21][22] However, traditional organic materials for fluorescence imaging and theranostics are always limited by the notorious aggregationcaused quenching (ACQ) effect due to π-π stacking, which makes easy photobleaching and low signal-to-noise ratio (SNR) as well as hampers further photodynamic therapy (PDT) and photothermal therapy (PTT) for cancer. [23] Opposite to the ACQ effect, the aggregation-induced emission (AIE) phenomenon was discovered by Tang's group in 2001 with large Stokes shift and strong photostability.…”