The Impact of Immune-checkpoint Inhibition on the Gastrointestinal Tract in Non-small Cell Lung Cancer

Immune-checkpoint inhibitor (ICI)-based immunotherapy has become one of the most effective and widely adopted therapeutic approaches in the field of onco-hematology. Among the various malignancies treated with immunotherapy, lung cancer stands out for the frequency and success of its use, ranging from the adjuvant, neoadjuvant, and perioperative settings to advanced metastatic disease. Despite its clinical success, the mechanisms underlying the full spectrum of immune-related adverse events (irAEs) remain poorly understood, with gastrointestinal (GI) toxicity among the most commonly observed complications. Timely recognition and management of these adverse events are therefore essential to prevent progression to severe, potentially irreversible clinical conditions. Corticosteroids continue to represent the mainstay of treatment for irAEs; however, emerging therapeutic agents are showing promise in improving outcomes and minimizing long-term toxicity. In this review, we will explore the primary GI immune-related toxicities associated with ICIs, discuss current management strategies, and examine their relationship with the use of immunotherapy in patients with non-small cell lung cancer (NSCLC).