Panneerselvam Kavea, Amin Rajan N, Wei Dongguang, Tan Dongfeng, Lum Phillip J, Zhang Hao Chi, Richards David M, Altan Mehmet, Grivas Petros, Thompson John A, Thomas Anusha S, Wang Yinghong
1Department of Internal Medicine, Baylor College of Medicine, Houston, Texas.
2Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas; and.
J Natl Compr Canc Netw. 2021 Jun 11;19(8):896-904. doi: 10.6004/jnccn.2020.7675.
Although immune checkpoint inhibitors (ICIs) have provided practice-changing outcomes in treating many cancers, ICI-related gastrointestinal toxicity can limit their use. Upper gastrointestinal toxicity is not common nor as well described as lower gastrointestinal toxicity. We aimed to characterize the clinical presentation, endoscopic and histologic features, treatment response, and outcomes of ICI-related esophagitis.
We retrospectively studied patients at The University of Texas MD Anderson Cancer Center in whom esophagitis developed after receiving ICIs from June 2011 through January 2020. We included patients with endoscopic evidence of esophagitis and excluded those with other obvious causes of esophagitis. A chi-square test was used to assess associations between categorical variables. The Mann-Whitney U test was used to compare differences between continuous variables.
Of 657 consecutive patients who underwent esophagogastroduodenoscopy (EGD) during or within 6 months of completing ICI-based therapy, 21 (3%) had esophagitis deemed to be from ICIs. Of these patients, 1 (5%) received an inhibitor of CTLA-4 alone, 15 (71%) received anti-PD-1 or PD-L1 monotherapy, and 5 (24%) received a combination of these. Median time from ICI initiation to onset of esophagitis was 4 months. Upon evaluation with EGD, only 3 patients (14%) had isolated esophageal involvement; 18 (86%) had concurrent involvement of the stomach, duodenum, or both. Most patients (67%) were treated with proton pump inhibitors, and 4 (19%) received steroids (prednisone or budesonide). The mortality rate was 38% (median follow-up, 15 months).
Esophagitis associated with ICI use is rare. The diagnosis is one of exclusion because its clinical presentation appears similar to that of inflammation resulting from other causes. It often occurs in conjunction with other upper gastrointestinal toxicity. Symptoms are mild and respond well to nonimmunosuppressive treatment, with few severe complications.
尽管免疫检查点抑制剂（ICI）在治疗多种癌症方面带来了改变临床实践的疗效，但ICI相关的胃肠道毒性会限制其应用。上消化道毒性并不常见，且不如下消化道毒性那样有详尽描述。我们旨在描述ICI相关食管炎的临床表现、内镜及组织学特征、治疗反应和结局。
我们回顾性研究了2011年6月至2020年1月在德克萨斯大学MD安德森癌症中心接受ICI治疗后发生食管炎的患者。我们纳入了有食管炎内镜证据的患者，并排除了有其他明显食管炎病因的患者。采用卡方检验评估分类变量之间的关联。采用曼-惠特尼U检验比较连续变量之间的差异。
在657例在接受基于ICI的治疗期间或结束后6个月内接受食管胃十二指肠镜检查（EGD）的连续患者中，21例（3%）有被认为是由ICI引起的食管炎。在这些患者中，1例（5%）仅接受了CTLA-4抑制剂治疗，15例（71%）接受了抗PD-1或PD-L1单药治疗，5例（24%）接受了这些药物的联合治疗。从开始使用ICI到发生食管炎的中位时间为4个月。经EGD评估，只有3例患者（14%）仅有食管受累；18例（86%）同时累及胃、十二指肠或两者。大多数患者（67%）接受了质子泵抑制剂治疗，4例（19%）接受了类固醇（泼尼松或布地奈德）治疗。死亡率为38%（中位随访时间为15个月）。
与ICI使用相关的食管炎很罕见。其诊断是一种排除性诊断，因为其临床表现与其他原因引起的炎症相似。它常与其他上消化道毒性同时发生。症状较轻，对非免疫抑制治疗反应良好，严重并发症较少。
