Wysocki Piotr T, Reguła Jarosław
Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland.
Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
Curr Treat Options Oncol. 2025 May;26(5):360-366. doi: 10.1007/s11864-025-01318-4. Epub 2025 Apr 11.
Budesonide is a potent topical glucocorticosteroid with limited systemic activity owing to its extensive hepatic first-pass metabolism following oral administration. Its efficacy and safety have been well-established in gastroenterology, particularly for inducing and maintaining remission in patients with inflammatory bowel diseases: mild-to-moderate ulcerative colitis, Crohn's disease and microscopic colitis. However, the potential role of oral budesonide in oncology has only recently been recognized, particularly for managing various types of gastrointestinal immune-related adverse events, which are among the most common toxicities observed in cancer patients treated with immune checkpoint inhibitors. Potential applications of oral budesonide in this context include the treatment of immunotherapy-induced microscopic and non-microscopic colitis, enteritis, upper gastrointestinal involvement, and, to a lesser extent, hepatitis. In these cases, oral budesonide may serve as a primary treatment to induce remission, replacing systemic steroids, or as a bridging therapy transitioning from systemic steroids, facilitating a quicker resumption of immunotherapy following its temporary discontinuation due to toxicity. Oral budesonide represents a particularly attractive treatment option in oncology due to its minimal systemic activity, low risk of steroid-related side effects, and very limited potential to cause immune suppression - offering a marked contrast to systemic steroids. In this article, we summarize the current evidence on the potential applications of oral budesonide in oncology, highlighting its promise as a targeted and well-tolerated treatment option for managing gastrointestinal immune-related toxicities that preserves the anti-cancer efficacy of immunotherapy.
布地奈德是一种强效的局部糖皮质激素，口服给药后由于广泛的肝脏首过代谢，其全身活性有限。其疗效和安全性在胃肠病学领域已得到充分证实，尤其在诱导和维持炎症性肠病患者缓解方面：轻度至中度溃疡性结肠炎、克罗恩病和显微镜下结肠炎。然而，口服布地奈德在肿瘤学中的潜在作用直到最近才被认识到，特别是在管理各种类型的胃肠道免疫相关不良事件方面，这些不良事件是接受免疫检查点抑制剂治疗的癌症患者中最常见的毒性反应之一。在这种情况下，口服布地奈德的潜在应用包括治疗免疫疗法引起的显微镜下和非显微镜下结肠炎、肠炎、上消化道受累，以及在较小程度上治疗肝炎。在这些病例中，口服布地奈德可作为诱导缓解的主要治疗方法，替代全身用类固醇，或作为从全身用类固醇过渡的桥接疗法，便于在因毒性而暂时停用免疫疗法后更快地恢复使用。口服布地奈德由于其最小的全身活性、类固醇相关副作用的低风险以及引起免疫抑制的可能性非常有限，在肿瘤学中是一种特别有吸引力的治疗选择——这与全身用类固醇形成了鲜明对比。在本文中，我们总结了关于口服布地奈德在肿瘤学中潜在应用的当前证据，强调了其作为一种有针对性且耐受性良好的治疗选择来管理胃肠道免疫相关毒性的前景，同时保留免疫疗法的抗癌疗效。
