Parente Paola, Maiorano Brigida Anna, Ciardiello Davide, Cocomazzi Francesco, Carparelli Sonia, Guerra Maria, Ingravallo Giuseppe, Cazzato Gerardo, Carosi Illuminato, Maiello Evaristo, Bossa Fabrizio
Pathology Unit, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, Viale Cappuccini 1, San Giovanni Rotondo, 71013 Foggia, Italy.
Oncology Unit, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71013 Foggia, Italy.
Diagnostics (Basel). 2022 Mar 11;12(3):685. doi: 10.3390/diagnostics12030685.
Immune checkpoint inhibitors (ICIs) have widened the therapeutic scenario of different solid tumors over the last ten years. Gastrointestinal (GI) adverse events (AEs), such as diarrhea and colitis, occur in up to 50% of patients treated with ICIs. We conducted a single-center retrospective analysis in patients with solid tumors treated with ICIs in a 6-year period, from 2015 to 2021, developing GI AEs, for which an endoscopic analysis was performed, with available histological specimens or surgery. Twenty-one patients developed GI AEs under ICIs. The median time from the start of ICIs to the onset of GI AEs was 5 months. Diarrhea was the most frequent symptom (57.2%), upper GI symptoms presented in four patients (19%), while three patients (14.3%) had no symptoms and were diagnosed occasionally. Two patients underwent surgical resection for acute abdomen. Histological findings observed in endoscopic sampling were eosinophilic-pattern gastro-enterocolitis, apoptotic damage, IBD-like features, and ischemic-like changes. Histological damage was also documented in patients with unremarkable endoscopy. Under ICI therapy, GI toxicity is an expected event. Since GIAEs can mimic a broad range of primary GI diseases, a multidisciplinary approach is advocated with upper and lower GI mucosal sampling to remodel therapy and avoid complications.
在过去十年中，免疫检查点抑制剂（ICIs）拓宽了不同实体瘤的治疗前景。胃肠道（GI）不良事件（AEs），如腹泻和结肠炎，在接受ICIs治疗的患者中发生率高达50%。我们对2015年至2021年这6年间接受ICIs治疗且出现胃肠道不良事件的实体瘤患者进行了单中心回顾性分析，对这些患者进行了内镜分析，并获取了可用的组织学标本或进行了手术。21名患者在ICIs治疗期间出现了胃肠道不良事件。从开始使用ICIs到出现胃肠道不良事件的中位时间为5个月。腹泻是最常见的症状（57.2%），4名患者出现上消化道症状（19%），而3名患者（14.3%）没有症状，是偶然被诊断出来的。两名患者因急腹症接受了手术切除。内镜取样观察到的组织学表现为嗜酸性模式的胃肠结肠炎、凋亡损伤、炎症性肠病样特征和缺血样改变。内镜检查无明显异常的患者也有组织学损伤记录。在ICI治疗下，胃肠道毒性是一个预期事件。由于胃肠道不良事件可能模仿多种原发性胃肠道疾病，因此提倡采用多学科方法，对上、下消化道黏膜进行取样，以调整治疗方案并避免并发症。
