免疫检查点抑制剂治疗患者的慢性胃肠道免疫相关不良事件。
Chronic gastrointestinal immune-related adverse events in patients exposed to immune checkpoint inhibitors.
机构信息
Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Université Paris-Saclay, Le Kremlin Bicêtre, 78 Rue du Général Leclerc, Le Kremlin-Bicêtre 94270, France.
Dermatology Unit, Department of Medicine, Gustave Roussy, Villejuif, France & Université Paris Saclay, Le Kremlin Bicêtre, France.
出版信息
Clin Res Hepatol Gastroenterol. 2024 Apr;48(4):102311. doi: 10.1016/j.clinre.2024.102311. Epub 2024 Feb 29.
BACKGROUND AND AIMS
Immune checkpoint inhibitors (ICI) cause acute gastrointestinal (GI) immune-related adverse events (IrAEs). We aimed to report and describe chronic GI IrAEs.
METHODS
We included consecutive patients addressed to a single center between October 2010 and March 2022 for endoscopic and/or histological GI inflammation persisting at least six months after the last dose of ICI.
RESULTS
Among a total of 178 patients addressed for GI IrAE, 14 met the inclusion criteria (8 %). The median follow-up was 13 months after discontinuation of ICI. The most common symptom was watery diarrhea (54 %). Ten (77 %) patients had colonic involvement and three patients (21 %) had ileal involvement. Ten patients (77 %) had inflammatory lesions, two patients (15 %) had fistulas and one patient had (8 %) a stricture. All patients had lymphoplasmacytic infiltrate and basal plasmacytosis, and seven (54 %) had crypt distortions. Nine patients (69 %) received medical therapy, including five patients treated with vedolizumab, two patients (15 %) underwent intestinal resection. At the last follow-up, seven of the 13 patients were receiving maintenance therapy. Endoscopic lesions persisted one year after discontinuing ICI in 4/6 patients, and two years after discontinuation in 3/4 patients.
CONCLUSIONS
Chronic GI IrAEs exist after ICI use.
背景与目的
免疫检查点抑制剂（ICI）可引起急性胃肠道（GI）免疫相关不良事件（IrAEs）。本研究旨在报告和描述慢性 GI IrAEs。
方法
我们纳入了自 2010 年 10 月至 2022 年 3 月在单一中心就诊的、接受 ICI 治疗后至少 6 个月内镜和/或组织学 GI 炎症持续存在的连续患者。
结果
在总共 178 例 GI IrAE 患者中，有 14 例符合纳入标准（8%）。ICI 停药后中位随访时间为 13 个月。最常见的症状是水样腹泻（54%）。10 例（77%）患者有结肠受累，3 例（21%）患者有回肠受累。10 例（77%）患者有炎症性病变，2 例（15%）患者有瘘管，1 例（8%）患者有狭窄。所有患者均有淋巴浆细胞浸润和基底浆细胞增多，7 例（54%）患者有隐窝扭曲。9 例（69%）患者接受了药物治疗，其中 5 例接受了 vedolizumab 治疗，2 例（15%）患者接受了肠切除术。在最后一次随访时，13 例患者中有 7 例正在接受维持治疗。6 例患者中，4 例在停止 ICI 治疗后 1 年时内镜下病变仍持续存在，3 例在停止治疗后 2 年时仍持续存在。
结论
ICI 使用后存在慢性 GI IrAEs。
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