Kiparizoska Sara, Murphy Megan E, Mattar Mark C
Department of Medicine, Medstar Georgetown University Hospital, Washington DC.
Department of Gastroenterology, Medstar Georgetown University Hospital, Washington DC.
Curr Opin Gastroenterol. 2023 Jan 1;39(1):43-49. doi: 10.1097/MOG.0000000000000892. Epub 2022 Nov 3.
Immune checkpoint inhibitors (ICI) have become a pillar of cancer therapy for many people around the world. However, up to two-thirds of all patients undergoing ICI therapy will have immune-related adverse events (irAEs), including immune-checkpoint inhibitor colitis (ICIC). This review summarizes the most valuable and currently available information about the mechanism, diagnosis, and management of ICIC.
Recent findings include several developments on the leading theories for the mechanisms of ICIC such as the role of the gut microbiome. New emerging therapy strategies include tocilizumab, ustekinumab, mycophenolate mofetil, and calcineurin inhibitors.
The occurrence of irAEs remains a limiting factor for the use of immunotherapy in cancer treatment. Prompt diagnosis of ICIC with endoscopy and histologic confirmation can lead to early utilization of known effective treatments such as corticosteroids, infliximab, vedolizumab, and other emerging therapy strategies. We summarize the key points of this review article in our abstract video, Supplemental Digital Content 1, http://links.lww.com/COG/A44.
免疫检查点抑制剂(ICI)已成为全球许多癌症患者治疗的支柱。然而,接受ICI治疗的所有患者中,高达三分之二会出现免疫相关不良事件(irAE),包括免疫检查点抑制剂结肠炎(ICIC)。本综述总结了有关ICIC的机制、诊断和管理的最有价值且当前可用的信息。
最新发现包括ICIC机制的主要理论的多项进展,如肠道微生物群的作用。新出现的治疗策略包括托珠单抗、乌司奴单抗、霉酚酸酯和钙调神经磷酸酶抑制剂。
irAE的发生仍然是免疫疗法在癌症治疗中应用的限制因素。通过内镜检查和组织学确认及时诊断ICIC,可促使早期使用已知的有效治疗方法,如皮质类固醇、英夫利昔单抗、维多珠单抗以及其他新出现的治疗策略。我们在摘要视频(补充数字内容1,http://links.lww.com/COG/A44)中总结了本文的要点。