Management of Challenging Immune-Related Gastrointestinal Adverse Events Associated with Immune Checkpoint Inhibitors

Abstract

Immune-related gastrointestinal toxicities (irGI) are well-known adverse events (AEs) with immune checkpoint inhibitors. The aim of this review was to present clinical data from 82 cases to provide information to clinicians who face real-world challenges among their patients with irGI AEs. The findings of this review support the use of the current management guidelines. By analyzing the treatment courses and outcomes of all cases identified, our review recommends that recurrent cases be treated carefully regardless of the grade of diarrhea at the onset of events. Earlier gastroenterology consultation and computed tomography/endoscopy diagnosis are essential, especially when an irGI AE recurs or worsens during steroid tapering. We would also suggest earlier decision to add immunosuppressant agents, particularly for recurrent cases.

Nivolumab‐induced celiac‐like enteropathy in patient with metastatic renal cell carcinoma: Case report and review of the literature

“…Even though nivolumab has a relatively good tolerance profile, it may induce severe immunologic toxicities that can occur at any time during or even after the treatment, and these side effects are of crucial importance for patient's care . Immune‐related gastrointestinal toxicities are among the most frequently observed and are dominated by colitis, while small intestine toxicities are much less frequent . Only one case of diffuse enteropathy, with immune infiltration extended from the duodenum to the colon, has been reported after a long‐term course of nivolumab in a patient with lung cancer .…”

“…[3][4][5][6] Immune-related gastrointestinal toxicities are among the most frequently observed and are dominated by colitis, while small intestine toxicities are much less frequent. 7,8 Only one case of diffuse enteropathy, with immune infiltration extended from the duodenum to the colon, has been reported after a long-term course of nivolumab in a patient with lung cancer. 9 Here we report a case of severe celiac-like enteropathy, without colitis, induced by nivolumab in patient with metastatic RCC.…”

Interactions between Biomedical Micro‐/Nano‐Motors and the Immune Molecules, Immune Cells, and the Immune System: Challenges and Opportunities

“…Consequently, approaches to deliver checkpoint inhibitors will be required to improve potency while decreasing toxic side effects. [ 73 ]…”

The Entire Intestinal Tract Surveillance Using Capsule Endoscopy after Immune Checkpoint Inhibitor Administration: A Prospective Observational Study

“…Colonoscopy, one of the essential examinations for diagnosing ICI-induced enterocolitis, has been recommended in the guidelines for the management of irAEs [16,22]. Repeat colonoscopy can also help in the evaluation of the treatment for ICI-induced enterocolitis [23]. Endoscopic findings of ICI-induced enterocolitis include a mucosa with diffuse ulceration, edema, and luminal bleeding over the entire or often segmental colon [24][25][26]; however, total colonoscopy for patients with severe symptoms is often difficult to perform.…”