Review Article
Management of Patients With Immune Checkpoint Inhibitor-Induced Enterocolitis: A Systematic Review

https://doi.org/10.1016/j.cgh.2020.01.033Get rights and content

Immune checkpoint inhibitors (ICIs) have improved the treatment of several cancers. These drugs increase T-cell activity and the antitumor immune response but also have immune-related adverse effects that can affect the gastrointestinal (GI) tract. These adverse effects have been observed in 7% to 30% of patients treated with ICIs. As the number of diseases treated with ICIs increases, gastroenterologists will see more patients with ICI-induced GI adverse events. We performed a systematic review of the incidence, risk factors, clinical manifestations, and management of the adverse effects of ICIs on the GI tract. Treatment with anti–cytotoxic T-lymphocyte–associated antigen-4 often causes severe enterocolitis, whereas treatment with inhibitors of programmed cell death 1 have less frequent and more diverse adverse effects. Management of patients with GI adverse effects of ICIs should involve first ruling out other disorders, followed by assessment of severity, treatment with corticosteroids, and rapid introduction of infliximab therapy for nonresponders.

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.

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    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.).

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