Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER) and Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. S.W., Rochester, MN, USA.
Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA.
Dig Dis Sci. 2021 Jun;66(6):1974-1980. doi: 10.1007/s10620-020-06440-x. Epub 2020 Aug 7.
Immune checkpoint inhibitors (ICI) have improved outcomes in patients with various malignancies; however, they can cause immune-related hepatitis and enterocolitis. Patients on ICI may also develop upper gastrointestinal symptoms and undergo measurement of gastric emptying.
Our aim was to review records of patients with gastroparesis following ICI therapy at two medical centers.
We performed a retrospective review of all patients at Mayo Clinic and Brigham and Women's/Dana-Farber Cancer Center (BWH/DFCC) who underwent gastric scintigraphy for the assessment of symptoms of gastroparesis following ICI treatment up to January 2020. Clinical presentation, medical history, laboratory evaluation, imaging, treatment, and outcomes were retrieved from the records. Gastroparesis was diagnosed as delayed gastric emptying (GE) measured by gastric scintigraphy.
At Mayo Clinic, 2 patients (median age 59 years, 1 male [M], 1 female [F]) had delayed GE, while 4 patients (median age 53 years, 3M, 1F) had normal GE following ICI use. Of those with delayed GE (diagnosed after 38 and 2 months of ICI initiation), 1 patient was treated for non-Hodgkin's lymphoma and melanoma with ipilimumab; a second patient with breast cancer was treated with pembrolizumab. At BWH/DFCC, 2 patients (median age 56 years, 1M, 1F) had normal GE after ICI treatment, while a 62-year-old female with non-small cell lung cancer developed gastroparesis 3 months following initiation of nivolumab.
This report documents gastroparesis as a potential adverse effect of ICI. Further studies should explore the potential for ICI therapy to damage anti-inflammatory macrophages that preserve the enteric neurons.
免疫检查点抑制剂（ICI）已改善了多种恶性肿瘤患者的预后；然而，它们可导致免疫相关性肝炎和肠炎。ICI 治疗的患者也可能出现上消化道症状并进行胃排空测量。
我们旨在审查两个医疗中心接受 ICI 治疗后发生胃轻瘫的患者记录。
我们对在梅奥诊所和布莱根妇女医院/达纳-法伯癌症中心（BWH/DFCC）接受胃闪烁显像术评估 ICI 治疗后胃轻瘫症状的所有患者进行了回顾性研究，直到 2020 年 1 月。从记录中检索了临床表现、病史、实验室评估、影像学、治疗和结局。胃轻瘫通过胃闪烁显像术诊断为胃排空延迟（GE）。
在梅奥诊所，2 例患者（中位年龄 59 岁，1 例男性[M]，1 例女性[F]）出现 GE 延迟，而 4 例患者（中位年龄 53 岁，3 例男性，1 例女性）在接受 ICI 治疗后出现 GE 正常。在 GE 延迟的患者中（在 ICI 开始后 38 和 2 个月诊断），1 例患有非霍奇金淋巴瘤和黑色素瘤的患者接受了伊匹单抗治疗；另 1 例患有乳腺癌的患者接受了 pembrolizumab 治疗。在 BWH/DFCC，2 例患者（中位年龄 56 岁，1 例男性，1 例女性）在接受 ICI 治疗后 GE 正常，而 1 例 62 岁的非小细胞肺癌女性患者在开始使用 nivolumab 3 个月后出现胃轻瘫。
本报告记录了 ICI 作为潜在的不良反应导致胃轻瘫。进一步的研究应探讨 ICI 治疗可能损害维持肠神经元的抗炎巨噬细胞的潜在机制。
