Dahiya Dushyant Singh, Wani Farah, Guidi Jean Claude, Kichloo Asim
Department of Internal Medicine, Central Michigan University, Saginaw, MI, USA.
Department of Family Medicine, Samaritan Medical Center, Watertown, NY, USA.
Gastroenterology Res. 2020 Dec;13(6):227-232. doi: 10.14740/gr1340. Epub 2020 Dec 23.
The utilization of immunotherapy is increasing to the point of becoming the fifth pillar of management alongside surgical intervention, chemotherapy, radiotherapy and targeted therapy. However, gastrointestinal adverse effects and toxicities have been frequently cited with its use. As per literature, the most common adverse effect of immune checkpoint inhibitors is watery and non-bloody diarrhea. Adoptive cell therapy can lead to delayed, on-target but off-tumor adverse effects which are unknown and may be life-threatening. The use of anti-angiogenic monoclonal antibodies can lead to bowel perforations, whereas epidermal growth factor receptor inhibitors and anti-HER2 agents are frequently associated with diarrhea. Minimal adverse effects have been associated with therapeutic cancer vaccines; however, additional studies are needed to determine their efficacy and potential toxicities. To provide an in-depth review of the gastrointestinal side effects of immunotherapeutic agents, we performed a thorough literature search using multiple online search engines such as PubMed, Google Scholar and Ovid MEDLINE, along with a review of the guidelines from the United States Food and Drug Administration (FDA) and the Cancer Research Institute on immunotherapy. In this systematic review, we detail the gastrointestinal adverse effects of immunotherapy and describe their management. With the advent of newer immunotherapeutic agents and the consistent approval of current agents by FDA for a wide spectrum of cancers, it is vital for physicians to familiarize themselves with their adverse effects for prompt diagnosis and early intervention to decrease adverse outcomes.
免疫疗法的应用正在不断增加，以至于它已成为继手术干预、化疗、放疗和靶向治疗之后的第五大治疗支柱。然而，其使用过程中经常出现胃肠道不良反应和毒性。根据文献记载，免疫检查点抑制剂最常见的不良反应是水样非血性腹泻。过继性细胞疗法可能导致延迟出现的、靶向但脱瘤的不良反应，这些反应尚不明确，且可能危及生命。使用抗血管生成单克隆抗体可能导致肠穿孔，而表皮生长因子受体抑制剂和抗HER2药物则常与腹泻有关。治疗性癌症疫苗的不良反应较少；然而，还需要更多研究来确定其疗效和潜在毒性。为了深入综述免疫治疗药物的胃肠道副作用，我们使用多个在线搜索引擎（如PubMed、谷歌学术和Ovid MEDLINE）进行了全面的文献检索，并查阅了美国食品药品监督管理局（FDA）和癌症研究所关于免疫疗法的指南。在本系统综述中，我们详细阐述了免疫疗法的胃肠道不良反应并描述了其管理方法。随着更新的免疫治疗药物的出现以及FDA对现有药物在多种癌症治疗上的持续批准，医生熟悉这些药物的不良反应以进行及时诊断和早期干预从而减少不良后果至关重要。
