Review ArticleManagement of Patients With Immune Checkpoint Inhibitor-Induced Enterocolitis: A Systematic Review
Section snippets
Methods
The present article is based on our experience and an updated systematic literature review. Since the ICI were started to be used, 133 patients with severe GI immune-related adverse effects have been hospitalized in our department. Many other patients were seen as outpatients or discussed within the Registre des Effets Indésirables Sévères des Anticorps Monoclonaux Immunomodulateurs en Cancérologie (REISAMIC) network, which is dedicated to immune-related adverse effects.2 The procedure of the
Acknowledgments
The authors would like to thank Sarah L. Williamson, graphic illustrator for the AGA journals.
References (93)
- et al.
Management of immune checkpoint blockade dysimmune toxicities: a collaborative position paper
Ann Oncol
(2016) - et al.
Immune-related adverse events with immune checkpoint blockade: a comprehensive review
Eur J Cancer
(2016) - et al.
Tumour- and class-specific patterns of immune-related adverse events of immune checkpoint inhibitors: a systematic review
Ann Oncol
(2017) - et al.
Immune-related adverse events from combination immunotherapy in cancer patients: a comprehensive meta-analysis of randomized controlled trials
Int Immunopharmacol
(2018) - et al.
Ipilimumab 10 mg/kg versus ipilimumab 3 mg/kg in patients with unresectable or metastatic melanoma: a randomised, double-blind, multicentre, phase 3 trial
Lancet Oncol
(2017) - et al.
Nivolumab alone and nivolumab plus ipilimumab in recurrent small-cell lung cancer (CheckMate 032): a multicentre, open-label, phase 1/2 trial
Lancet Oncol
(2016) - et al.
Programmed cell death protein-1 (PD1) inhibitor therapy in patients with advanced melanoma and preexisting autoimmunity or ipilimumab-triggered autoimmunity
Eur J Cancer
(2017) - et al.
Baseline gut microbiota predicts clinical response and colitis in metastatic melanoma patients treated with ipilimumab
Ann Oncol
(2017) - et al.
Immune checkpoint inhibition-related colitis: symptoms, endoscopic features, histology and response to management
ESMO Open
(2018) - et al.
Clinical, endoscopic, and histologic characteristics of ipilimumab-associated colitis
Clin Gastroenterol Hepatol
(2016)
Evolution and recurrence of gastrointestinal immune-related adverse events induced by immune checkpoint inhibitors
Eur J Cancer
Inflammatory gastrointestinal diseases associated with PD1 blockade antibodies
Ann Oncol
Immune-checkpoint inhibitor-induced diarrhea and colitis in patients with advanced malignancies: retrospective review at MD Anderson
J Immunother Cancer
Cytomegalovirus reactivation in patients with refractory checkpoint inhibitor-induced colitis
Eur J Cancer
Management of toxicities from immunotherapy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
Ann Oncol
Efficacy of nivolumab and pembrolizumab in patients with advanced non–small-cell lung cancer needing treatment interruption because of adverse events: a retrospective multicenter analysis
Clin Lung Cancer
Early immune-related adverse events and association with outcome in advanced non–small cell lung cancer patients treated with nivolumab: a prospective cohort study
J Thorac Oncol
Metagenomic shotgun sequencing and unbiased metabolomic profiling identify specific human gut microbiota and metabolites associated with immune checkpoint therapy efficacy in melanoma patients
Neoplasia
Safety of resuming anti-PD1 in patients with immune-related adverse events (immune-related adverse effects) during combined anti-CTLA4 and anti-PD1 in metastatic melanoma
Ann Oncol
Safety profiles of anti-CTLA4 and anti-PD1 antibodies alone and in combination
Nat Rev Clin Oncol
Enterocolitis due to immune checkpoint inhibitors: a systematic review
Gut
Immune-related adverse events for anti-PD1 and anti-PD-L1 drugs: systematic review and meta-analysis
BMJ
Comprehensive meta-analysis of key immune-related adverse events from CTLA4 and PD1/PD-L1 inhibitors in cancer patients
Cancer Immunol Res
Meta-analysis of the risk of immune-related adverse events with anticytotoxic T-lymphocyte-associated antigen 4 and antiprogrammed death 1 therapies
Clin Pharmacol Ther
The risk of diarrhea and colitis in patients with advanced melanoma undergoing immune checkpoint inhibitor therapy: a systematic review and meta-analysis
J Immunother
Incidence of immune checkpoint inhibitor-related colitis in solid tumor patients: a systematic review and meta-analysis
Oncoimmunology
Immune-related adverse events associated with anti-PD1/PD-L1 treatment for malignancies: a meta-analysis
Front Pharmacol
Adverse effects of immune checkpoint therapy in cancer patients visiting the emergency department of a comprehensive cancer center
Ann Emerg Med
Rapid complete response of metastatic melanoma in a patient undergoing ipilimumab immunotherapy in the setting of active ulcerative colitis
J Immunotherapy Cancer
Ipilimumab therapy in patients with advanced melanoma and preexisting autoimmune disorders
JAMA Oncol
Ipilimumab in metastatic melanoma patients with pre-existing autoimmune disorders
Cancer Immunol Immunother
Anti-PD1 therapy in patients with advanced melanoma and preexisting autoimmune disorders or major toxicity with ipilimumab
Ann Oncol
Safety of programmed death–1 pathway inhibitors among patients with non–small-cell lung cancer and preexisting autoimmune disorders
J Clin Oncol
Pre-existing autoimmune disease and the risk of immune-related adverse events among patients receiving checkpoint inhibitors for cancer
Cancer Immunol Immunother
Cancer immunotherapy with anti-CTLA4 monoclonal antibodies induces an inflammatory bowel disease
J Crohns Colitis
Impact of age on outcomes with immunotherapy for patients with melanoma
Oncologist
Intestinal microbiome analyses identify melanoma patients at risk for checkpoint-blockade-induced colitis
Nat Commun
A whole-blood RNA transcript-based gene signature is associated with the development of CTLA4 blockade-related diarrhea in patients with advanced melanoma treated with the checkpoint inhibitor tremelimumab
J Immunother Cancer
Enterocolitis in patients with cancer after antibody blockade of cytotoxic T-lymphocyte-associated antigen 4
J Clin Oncol
Ipilimumab-induced colitis in patients with metastatic melanoma
Melanoma Res
Ipilimumab-induced colitis: experience from a tertiary referral center
Therap Adv Gastroenterol
Patterns of onset and resolution of immune-related adverse events of special interest with ipilimumab: detailed safety analysis from a phase 3 trial in patients with advanced melanoma
Cancer
Immune-related adverse events, need for systemic immunosuppression, and effects on survival and time to treatment failure in patients with melanoma treated with ipilimumab at Memorial Sloan Kettering Cancer Center
J Clin Oncol
Prolonged survival in stage III melanoma with ipilimumab adjuvant therapy
N Engl J Med
Improved survival with ipilimumab in patients with metastatic melanoma
N Engl J Med
Fatal toxic effects associated with immune checkpoint inhibitors: a systematic review and meta-analysis
JAMA Oncol
Cited by (51)
Chronic gastrointestinal immune-related adverse events in patients exposed to immune checkpoint inhibitors
2024, Clinics and Research in Hepatology and GastroenterologyEnterocolitis and other immunotherapy and targeted therapy-related gastrointestinal manifestations: A review for gastroenterologist
2024, Revista de Gastroenterologia de MexicoManagement of toxicities from immunotherapy: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up <sup>☆</sup>
2022, Annals of OncologyCitation Excerpt :The maximum delay between ICI discontinuation and IR-enterocolitis is 2 months with anti-CTLA-4 and 1 year with anti-PD-1. Incidence rates of all-grade diarrhoea and colitis are ∼35% and ∼10% with anti-CTLA-4, ∼10% and ∼1% with anti-PD-1 and ∼32% and ∼15% with the combination, respectively.38 Approximately 40% of patients with pre-existing inflammatory bowel disease have a flare-up while undergoing ICI treatment, half of whom experience a moderate to severe grade based on CTCAE version 5.0 criteria (Supplementary Table S1, available at https://doi.org/10.1016/j.annonc.2022.10.001).39
Management of immune checkpoint inhibitor in patients with cancer and pre-existing inflammatory bowel disease: Recommendations from the GETAID
2022, Digestive and Liver DiseaseCitation Excerpt :However, activating the immune system with ICIs may lead to off-target immune-related adverse events including ICI-mediated diarrhoea and colitis (IMDC) [3,4]. Incidence of all grade diarrhoea has been estimated in 11–17% with anti-PD-1, 35–40% with anti-CTLA-4 and 32% with combination therapy of the latter ICI classes [5–8]. Concerning colitis, incidence has been estimated in 0.3–3.4% with anti-PD1, 8.4–11.3% with anti-CTLA-4, and 14% with combination [6,8–10].
Metastatic renal cell carcinoma: Management of toxicities of combinations
2022, Bulletin du Cancer
Conflicts of interest The authors disclose the following: Michael Collins has received travel accommodations from AbbVie, Takeda, and MSD, has served as an Advisory Board Member for AbbVie and Celgene, and has received lecture fees from AbbVie, Takeda, MSD, and Celgene; Franck Carbonnel has received personal fees from AbbVie, Amgen, Astra, BMS, Enterome, Ferring, Janssen, Medtronic, Merck, MSD, Pfizer, Pharmacosmos, Pileje, Roche, and Takeda; Emilie Soularue has received travel accommodations from Sanofi and Ipssen, and lecture fees from BMS; and Lysiane Marthey has received lecture fees from Takeda.
Funding Supported by Fondation pour la Recherche Médicale doctoral grant FDM 20170839109 (M.C.).