Tom 15, Nr 1 (2023)
Opis przypadku
Opublikowany online: 2024-05-28
Wyświetlenia strony 36
Wyświetlenia/pobrania artykułu 2
Pobierz cytowanie

Eksport do Mediów Społecznościowych

Eksport do Mediów Społecznościowych

Zapalenie jelita grubego po immunoterapii

Marta Zaborowska1, Andrzej Pawełas12, Edyta Zagórowicz12
DOI: 10.5603/gek.99710
Gastroenterologia Kliniczna 2023;15(1):44-49.

Streszczenie

Zastosowanie inhibitorów punktu kontrolnego (ICIs, immune checkpoint inhibitors) w terapii onkologicznej zmieniło strategię leczenia nowotworów w zaawansowanym stadium choroby. Leczenie to wiąże się jednak z występowaniem działań niepożądanych, przy czym do najczęstszych w immunoterapii należy biegunka, która wymaga przerwania leczenia onkologicznego. W różnicowaniu przyczyny biegunki oprócz infekcji należy wziąć pod uwagę zapalenie jelit o podłożu autoimmunologicznym (IR-colitis, immune related colits) oraz zaostrzenie nieswoistej choroby zapalnej jelit. Celem poniższej publikacji jest przedstawienie zasad diagnostyki oraz leczenia biegunki związanej ze stosowaniem inhibitorów punktu kontrolnego na podstawie przypadków klinicznych pacjentów onkologicznychotrzymujących immunoterapię.

Artykuł dostępny w formacie PDF

Dodaj do koszyka: 49,00 PLN

Posiadasz dostęp do tego artykułu?

Referencje

  1. Domagała-Kulawik J, Leszek P, Owczarek W, et al. Immunotherapy of solid tumors: safety of treatment. Pol Arch Intern Med. 2020; 130(9): 766–778.
  2. Carlino MS, Larkin J, Long GV. Immune checkpoint inhibitors in melanoma. Lancet. 2021; 398(10304): 1002–1014.
  3. Gong Z, Wang Y. Immune checkpoint inhibitor-mediated diarrhea and colitis: a clinical review. JCO Oncol Pract. 2020; 16(8): 453–461.
  4. Dougan M. Checkpoint blockade toxicity and immune homeostasis in the gastrointestinal tract. Front Immunol. 2017; 8: 1547.
  5. Geukes Foppen MH, Rozeman EA, van Wilpe S, et al. Immune checkpoint inhibition-related colitis: symptoms, endoscopic features, histology and response to management. ESMO Open. 2018; 3(1): e000278.
  6. Wang Y, Abu-Sbeih H, Mao E, et al. Endoscopic and histologic features of immune checkpoint inhibitor-related colitis. Inflamm Bowel Dis. 2018; 24(8): 1695–1705.
  7. Abu-Sbeih H, Faleck DM, Ricciuti B, et al. Immune checkpoint inhibitor therapy in patients with preexisting inflammatory bowel disease. J Clin Oncol. 2020; 38(6): 576–583.
  8. Shirwaikar Thomas A, Hanauer S, Wang Y. Immune checkpoint inhibitor enterocolitis vs idiopathic inflammatory bowel disease. Clin Gastroenterol Hepatol. 2023; 21(4): 878–890.
  9. Haanen J, Obeid M, Spain L, et al. Management of toxicities from immunotherapy: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022; 33(12): 1217–1238.
  10. Abdel-Wahab N, Shah M, Lopez-Olivo MA, et al. Use of immune checkpoint inhibitors in the treatment of patients with cancer and preexisting autoimmune disease: a systematic review. Ann Intern Med. 2018; 168(2): 121–130.
  11. Braga Neto MB, Ramos GP, Loftus EV, et al. Use of immune checkpoint inhibitors in patients with pre-established inflammatory bowel diseases: retrospective case series. Clin Gastroenterol Hepatol. 2021; 19(6): 1285–1287.e1.
  12. Gutzmer R, Koop A, Meier F, et al. German Dermatooncology Group (DeCOG). Programmed cell death protein-1 (PD-1) inhibitor therapy in patients with advanced melanoma and preexisting autoimmunity or ipilimumab-triggered autoimmunity. Eur J Cancer. 2017; 75: 24–32.
  13. Menzies AM, Johnson DB, Ramanujam S, et al. Anti-PD-1 therapy in patients with advanced melanoma and preexisting autoimmune disorders or major toxicity with ipilimumab. Ann Oncol. 2017; 28(2): 368–376.
  14. Kuang AG, Mohajir W, Panneerselvam K, et al. Diarrhea and colitis related to immune checkpoint inhibitor and BRAF/MEK inhibitor therapy. Ann Gastroenterol. 2023; 36(1): 45–53.
  15. Abu-Sbeih H, Ali FS, Luo W, et al. Importance of endoscopic and histological evaluation in the management of immune checkpoint inhibitor-induced colitis. J Immunother Cancer. 2018; 6(1): 95.
  16. Adler BL, Pezhouh MK, Kim A, et al. Histopathological and immunophenotypic features of ipilimumab-associated colitis compared to ulcerative colitis. J Intern Med. 2018; 283(6): 568–577.
  17. Choi K, Abu-Sbeih H, Samdani R, et al. Can immune checkpoint inhibitors induce microscopic colitis or a brand new entity? Inflamm Bowel Dis. 2019; 25(2): 385–393.
  18. Kubo K, Kato M, Mabe K. Nivolumab-Associated colitis mimicking ulcerative colitis. Clin Gastroenterol Hepatol. 2017; 15(9): A35–A36.
  19. Rawa T, Reguła J. Management of gastrointestinal toxicity from nivolumab therapy. Oncol Clin Pract. 2017; 13: 225–229.
  20. Horvat TZ, Adel NG, Dang TO, et al. Immune-Related adverse events, need for systemic immunosuppression, and effects on survival and time to treatment failure in patients with melanoma treated with ipilimumab at memorial sloan kettering cancer center. J Clin Oncol. 2015; 33(28): 3193–3198.
  21. Abu-Sbeih H, Ali FS, Alsaadi D, et al. Outcomes of vedolizumab therapy in patients with immune checkpoint inhibitor-induced colitis: a multi-center study. J Immunother Cancer. 2018; 6(1): 142.
  22. Apostolova P, Unger S, von Bubnoff D, et al. Extracorporeal photopheresis for colitis induced by checkpoint-inhibitor therapy. N Engl J Med. 2020; 382(3): 294–296.
  23. Thomas AS, Ma W, Wang Y. Ustekinumab for refractory colitis associated with immune checkpoint inhibitors. N Engl J Med. 2021; 384(6): 581–583.
  24. Johnson DH, Zobniw CM, Trinh VA, et al. Infliximab associated with faster symptom resolution compared with corticosteroids alone for the management of immune-related enterocolitis. J Immunother Cancer. 2018; 6(1): 103.
  25. Delasos L, Desai A, Lopetegui Lia N, et al. A case of immunotherapy-induced colitis complicated by perforation and treated with infliximab postoperatively. Case Rep Oncol Med. 2019; 2019: 9069354.
  26. Kennedy LC, Grivas P. Immunotherapy-Related colitis: an emerging challenge and a quest for prospective data. JCO Oncol Pract. 2020; 16(8): 464–465.



Gastroenterologia Kliniczna. Postępy i Standardy