Immunotherapy induced enterocolitis and gastritis - What to do and when?

Area of Science:

• Oncology
• Immunology
• Gastroenterology

Background:

• Immune checkpoint inhibitors (ICPi) have transformed cancer therapy by enhancing anti-tumour immune responses.
• A significant challenge with ICPi is the occurrence of immune-related adverse events, particularly gastrointestinal toxicities such as enterocolitis and gastritis.
• These ICPi-induced gastrointestinal conditions can necessitate treatment interruption, impacting patient outcomes.

Purpose of the Study:

• To review the pathogenesis of immune checkpoint inhibitor-induced gastrointestinal disease.
• To focus on the practical management strategies for ICPi-induced enterocolitis and gastritis.
• To highlight the need for prospective research into the immuno-microbiology of these conditions for improved patient care.

Main Methods:

• This is a review article, synthesizing existing knowledge on ICPi-induced gastrointestinal disease.
• It discusses the mechanisms underlying ICPi's effects on the gastrointestinal tract.
• It outlines current treatment approaches, including corticosteroids and biologic therapies.

Main Results:

• ICPi-enterocolitis is a common, often early-onset side effect that can lead to treatment cessation.
• ICPi-gastritis typically presents later with symptoms like nausea and vomiting.
• Corticosteroids are the primary treatment, with biologics reserved for refractory cases.

Conclusions:

• Effective management of ICPi-induced gastrointestinal disease is crucial for maintaining cancer therapy.
• Further research is essential to understand the immuno-microbiology of ICPi-enterocolitis and gastritis.
• Developing predictive biomarkers and optimizing treatment regimens are key future directions.