Treatment of immune checkpoint inhibitor-related colitis: a narrative review.

IF 1.5 4区医学 Q4 ONCOLOGY Translational cancer research Pub Date : 2024-12-31 Epub Date: 2024-12-27 DOI:10.21037/tcr-24-2150

Shiyang Wang, Hanping Wang

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Abstract

Background and objective: Cancer is one of the most difficult diseases facing modern medicine, and increasing amounts of research and clinical treatments are being applied to the treatment of cancer. Immunotherapy, particularly immune checkpoint inhibitor (ICI) therapy, has revolutionized the treatment and overall survival of patients with several different types of cancer. Approximately one-third of patients treated with ICIs may experience immune-related adverse events (irAEs). Immune checkpoint inhibitor-associated colitis (ICIC) is the most common irAE with an incidence of approximately 8-10%, ICIC usually presents as watery or bloody diarrhea, and if the symptoms are severe, ICI treatment must be interrupted or even terminated. This review summarizes the epidemiology, pathogenesis, clinical characteristics, and therapies of ICIC, focusing on the use of biologics, in order to propose treatment options in different situations to control immune checkpoint inhibitor-related colitis as soon as possible.

Methods: To find relevant articles for this narrative review paper, a combination of keywords such as immune checkpoint inhibitor-related colitis, corticosteroids, biologics were searched for in PubMed databases.

Key content and findings: The pathogenesis of ICIC is complex and primarily involves antitumor effects and indirect damage to colonic tissues, as well as the activation of specific proinflammatory pathways. Corticosteroids (CSs) are the first line of treatment for ICIC, but steroid-refractory or steroid-resistant cases often occur. Patients with irAE colitis respond favorably to biologics, and patients with CS-resistant/refractory enterocolitis can benefit from the early use of biologics.

Conclusions: Biologics are currently recommended for the treatment of ICIC but are usually used as a supplement after the failure of first-line CS therapy. Patients with irAE colitis respond favorably to biologics, and patients with CS-resistant/refractory enterocolitis can benefit from the early use of biologics. Biologics (alone or in combination with CS) should be considered as an early therapy option for high-risk patients rather than just an escalation after a failure to respond to CS.

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免疫检查点抑制剂相关结肠炎的治疗：叙述性回顾

背景与目的：癌症是现代医学面临的最困难的疾病之一，越来越多的研究和临床治疗正在应用于癌症的治疗。免疫疗法，特别是免疫检查点抑制剂（ICI）疗法，已经彻底改变了几种不同类型癌症患者的治疗和总体生存率。大约三分之一接受ICIs治疗的患者可能经历免疫相关不良事件（irAEs）。免疫检查点抑制剂相关性结肠炎（ICIC）是最常见的irAE，发病率约为8-10%，ICIC通常表现为水样或带血腹泻，如果症状严重，必须中断甚至终止ICI治疗。本文综述了ICIC的流行病学、发病机制、临床特点和治疗方法，重点介绍了生物制剂的应用，以期在不同情况下提出治疗方案，尽快控制免疫检查点抑制剂相关性结肠炎。方法：结合免疫检查点抑制剂相关性结肠炎、皮质类固醇、生物制剂等关键词，在PubMed数据库中检索相关文献。关键内容和发现：ICIC的发病机制复杂，主要涉及抗肿瘤作用和对结肠组织的间接损伤，以及特异性促炎途径的激活。皮质类固醇（CSs）是ICIC的一线治疗方法，但经常发生类固醇难治性或类固醇抵抗性病例。irAE型结肠炎患者对生物制剂反应良好，cs耐药/难治性小肠结肠炎患者可从早期使用生物制剂中获益。结论：生物制剂目前被推荐用于治疗ICIC，但通常作为一线CS治疗失败后的补充。irAE型结肠炎患者对生物制剂反应良好，cs耐药/难治性小肠结肠炎患者可从早期使用生物制剂中获益。生物制剂（单独使用或与CS联合使用）应被视为高危患者的早期治疗选择，而不仅仅是CS无效后的升级治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Translational cancer research ONCOLOGY-

CiteScore

2.10

自引率

0.00%

发文量

252

期刊介绍： Translational Cancer Research (Transl Cancer Res TCR; Print ISSN: 2218-676X; Online ISSN 2219-6803; http://tcr.amegroups.com/) is an Open Access, peer-reviewed journal, indexed in Science Citation Index Expanded (SCIE). TCR publishes laboratory studies of novel therapeutic interventions as well as clinical trials which evaluate new treatment paradigms for cancer; results of novel research investigations which bridge the laboratory and clinical settings including risk assessment, cellular and molecular characterization, prevention, detection, diagnosis and treatment of human cancers with the overall goal of improving the clinical care of cancer patients. The focus of TCR is original, peer-reviewed, science-based research that successfully advances clinical medicine toward the goal of improving patients'' quality of life. The editors and an international advisory group of scientists and clinician-scientists as well as other experts will hold TCR articles to the high-quality standards. We accept Original Articles as well as Review Articles, Editorials and Brief Articles.