Prieux-Klotz Caroline, Dior Marie, Damotte Diane, Dreanic Johann, Brieau Bertrand, Brezault Catherine, Abitbol Vered, Chaussade Stanislas, Coriat Romain
Department of Gastroenterology, Cochin Teaching Hospital, 27, rue du faubourg Saint Jacques, 75014, Paris, France.
Sorbonne Paris Cité, Faculté de Médecine, Université Paris Descartes, Paris, France.
Target Oncol. 2017 Jun;12(3):301-308. doi: 10.1007/s11523-017-0495-4.
Immune checkpoint inhibitors are monoclonal antibodies indicated for an increasing number of malignant diseases. These agents can cause specific side effects, which need to be anticipated while clear patterns of management need to be established. Immune checkpoint inhibitor-mediated gastrointestinal side effects, including diarrhea and colitis, occur in up to 30% of patients. Severe colitis can lead to severe dehydration or intestinal perforation. Endoscopic lesions and histopathological features of immune checkpoint inhibitor-induced colitis are similar to an inflammatory bowel disease (IBD) flare. Patients with immune checkpoint inhibitor-induced diarrhea and colitis are treated with corticosteroids. Infliximab can be used in cases of corticosteroid failure. Rectosigmoïdoscopy or colonoscopy should be performed when severe immune checkpoint inhibitor-induced colitis is suspected, but endoscopic investigations should not delay treatment. Specific patient education as well as co-operation between oncologists and gastroenterologists is essential.
免疫检查点抑制剂是针对越来越多恶性疾病的单克隆抗体。这些药物会引起特定的副作用，需要提前预见，同时需要建立明确的管理模式。免疫检查点抑制剂介导的胃肠道副作用，包括腹泻和结肠炎，在高达30%的患者中出现。严重的结肠炎可导致严重脱水或肠穿孔。免疫检查点抑制剂诱导的结肠炎的内镜病变和组织病理学特征与炎症性肠病（IBD）发作相似。免疫检查点抑制剂诱导的腹泻和结肠炎患者用皮质类固醇治疗。英夫利昔单抗可用于皮质类固醇治疗失败的病例。怀疑有严重的免疫检查点抑制剂诱导的结肠炎时应进行直肠乙状结肠镜检查或结肠镜检查，但内镜检查不应延误治疗。对患者进行特定的教育以及肿瘤学家和胃肠病学家之间的合作至关重要。
