A Comprehensive Review on Immune Checkpoint Inhibitor-induced Colitis

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A Comprehensive Review on Immune Checkpoint Inhibitor-induced Colitis

May 22, 2021 Medicine and Medical 0

Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that target anti-cancer immune response down-regulators such as cytotoxic T-lymphocyte antigen-4, programmed cell death protein-1, and its receptor programmed death-ligand 1. Checkpoint inhibitors are known to cause IMC, which is one of the most common side effects. The immune system plays a crucial role in detecting and removing malignancies.

ICIs have also revolutionised the treatment of a variety of malignancies. However, there have been a number of immune-related side effects reported, the most of which arise when the immune system becomes less controlled and affects numerous organs, including the gastrointestinal tract, resulting in diarrhoea and colitis. Depending on the kind of ICI and if it is used in combination, the risk of immune-mediated colitis (IMC) ranges from 1% to 25%. IMC and inflammatory bowel disease have a lot of similarities endoscopically and histologically, however IMC usually has greater neutrophilic inflammation without persistent inflammation. While on immunotherapy, corticosteroids are advised for grade 2 or greater severe colitis. Between one-third and two-thirds of patients who are steroid refractory benefit from infliximab. In steroid and infliximab-resistant conditions, vedolizumab has recently been demonstrated to be efficacious. The decision in grade 3 colitis is arguable if immunotherapy is permanently halted in grade 4 colitis.

Author(s) Details

Aniruddh Som
Department of Internal Medicine, Medstar Washington Hospital Center, Washington, DC 20010, United States.

Rohan Mandaliya
Department of Gastroenterology, MedStar Georgetown University Hospital, Washington, DC 20007, United States.

Dana Alsaadi
Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, DC 20007, United States.

Maham Farshidpour
Department of Internal Medicine, MedStar Union Memorial Hospital and Good Samaritan Hospital, Baltimore, MD 21218, United States.

Aline Charabaty
Department of Gastroenterology, Sibley Memorial Hospital, Washington, DC 20007, United States.

Nidhi Malhotra
Department of Gastroenterology, MedStar Washington Hospital Center, Washington, DC 20010, United States.

Mark C. Mattar
Department of Gastroenterology, MedStar Georgetown University Hospital, Washington, DC 20007, United States.

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