Management of Gastrointestinal Toxicity from Immune Checkpoint Inhibitor

Abstract

Immune checkpoint inhibitors have shown anti-tumour activity in cancers such as melanoma, renal cell carcinoma, non-small-cell lung cancer, urothelial carcinoma, colorectal cancer, and Hodgkin’s lymphoma. Though immune checkpoint inhibitors have revolutionized the treatment and prognosis of some advanced malignancies, they are also associated with a significant risk of immune-related adverse events. These adverse events can occur in any organ system, but gastrointestinal side effects are among the most commonly reported, with manifestations ranging from mild diarrhoea to severe colitis, sharing some features with inflammatory bowel disease. Anticipating a greater use of these drugs in the future, gastroenterologists should expect to be increasingly faced with gastrointestinal immune-related adverse events. Knowledge of these toxicities, as well as effective management algorithms, is essential to enable early diagnosis and treatment, decreasing morbidity and mortality. We reviewed the currently available literature on gastrointestinal toxicity induced by immune checkpoint inhibitors, namely the clinical features, diagnosis, and management.

Gastrointestinal Adverse Effects of Immunotherapeutic Agents: A Systematic Review

“…The gold standard test to establish a definitive diagnosis of ICI-induced colitis is endoscopic evaluation with biopsy followed by a histopathological analysis of the specimen [ 13 ]. The grades of diarrhea and colitis are summarized in Table 1 [ 14 ]. The management of GI toxicity with the use of ICIs is based on the degree of severity and can be summarized as follows [ 14 , 15 ].…”

“…The grades of diarrhea and colitis are summarized in Table 1 [ 14 ]. The management of GI toxicity with the use of ICIs is based on the degree of severity and can be summarized as follows [ 14 , 15 ]. 1) Mild diarrhea/colitis (grade 1): The management is usually supportive with antidiarrheals, fluids and electrolyte replacement.…”

Checkpoint Inhibitor-Induced Gastroduodenitis: An Unusual Manifestation

“…Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission. GE Port J Gastroenterol 2021;28:150-152 DOI: 10.1159/000509196 toxic T lymphocyte antigen 4 (CTLA-4) pathway or the programmed cell death protein 1 (PD-1) pathway [1,2]. However, their use can lead to autoimmune-like side effects, designated as immune-related adverse events (irAEs) that can affect almost all organ systems [1,2].…”

“…However, their use can lead to autoimmune-like side effects, designated as immune-related adverse events (irAEs) that can affect almost all organ systems [1,2]. Gastrointestinal toxicity, most commonly manifested by diarrhea, is the second most common irAE [1][2][3]. The upper gastrointestinal tract is rarely involved, and clinical manifestations include nausea, vomiting, dysphagia, and epigastric pain [1][2][3].…”

“…Immune-checkpoint inhibitors (ICI) are a class of immunotherapy drugs that lead to an antineoplastic immune response by blocking signalling via either the cytotoxic T lymphocyte antigen 4 (CTLA-4) pathway or the programmed cell death protein 1 (PD-1) pathway [1, 2]. However, their use can lead to autoimmune-like side ­effects, designated as immune-related adverse events (irAEs) that can affect almost all organ systems [1, 2]. Gastrointestinal toxicity, most commonly manifested by diarrhea, is the second most common irAE [1-3].…”