PMID- 31723355
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220411
IS  - 1756-283X (Print)
IS  - 1756-2848 (Electronic)
IS  - 1756-283X (Linking)
VI  - 12
DP  - 2019
TI  - Immune checkpoint inhibitor-associated gastrointestinal and hepatic adverse 
      events and their management.
PG  - 1756284819884196
LID - 10.1177/1756284819884196 [doi]
LID - 1756284819884196
AB  - BACKGROUND: Drug-induced colitis is a known complication of therapies that alter 
      the immune balance, damage the intestinal barrier or disturb intestinal 
      microbiota. Immune checkpoint inhibitors (ICI) directed against cancer cells may 
      result in activated T lymphocyte-induced immune-related adverse events (AEs), 
      including immune-related colitis and hepatitis. The aim of this review article is 
      to summarize the incidence of gastrointestinal (GI) and hepatic AEs related to 
      ICI therapy. We have also looked at the pathogenesis of immune-mediated AEs and 
      propose management strategies based on current available evidence. METHODS: A 
      literature search using PubMed and Medline databases was undertaken using 
      relevant search terms pertaining to names of individual drugs, mechanism of 
      action, related AEs and their management. RESULTS: ICI-related GI AEs are common, 
      and colitis appears to be the most common side effect, with some studies 
      reporting incidence as high as 30%. The incidence of both all-grade colitis and 
      hepatitis were highest with combination therapy with anti-CTLA-4/PD-1; severity 
      of colitis was dose-dependent (anti-CTLA-4). Early intervention is associated 
      with better outcomes. CONCLUSION: ICI-related GI and hepatic AEs are common and 
      clinicians need to be aware. Patients with GI AEs benefit from early diagnosis 
      using endoscopy and computed tomography. Early intervention with oral steroids is 
      effective in the majority of patients, and in steroid-refractory colitis 
      infliximab and vedolizumab have been reported to be useful; mycophenolate has 
      been used for steroid-refractory hepatitis.
CI  - (c) The Author(s), 2019.
FAU - Shivaji, Uday N
AU  - Shivaji UN
AUID- ORCID: 0000-0002-6800-584X
AD  - National Institute for Health Research (NIHR) Birmingham Biomedical Research 
      Centre, UK.
FAU - Jeffery, Louisa
AU  - Jeffery L
AD  - National Institute for Health Research (NIHR) Birmingham Biomedical Research 
      Centre, UK.
FAU - Gui, Xianyong
AU  - Gui X
AD  - Department of Pathology, University of Washington, Seattle, WA, USA.
FAU - Smith, Samuel C L
AU  - Smith SCL
AD  - Institute of Immunology and Immunotherapy, University of Birmingham, UK.
FAU - Ahmad, Omer F
AU  - Ahmad OF
AD  - Department of Gastroenterology, University College London Hospital, London, UK.
FAU - Akbar, Ayesha
AU  - Akbar A
AD  - St Mark's Hospital, IBD Unit, London, UK.
FAU - Ghosh, Subrata
AU  - Ghosh S
AD  - National Institute for Health Research (NIHR) Birmingham Biomedical Research 
      Centre, UK.
FAU - Iacucci, Marietta
AU  - Iacucci M
AD  - National Institute for Health Research (NIHR) Birmingham Biomedical Research 
      Centre, UK.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20191105
PL  - England
TA  - Therap Adv Gastroenterol
JT  - Therapeutic advances in gastroenterology
JID - 101478893
PMC - PMC6831976
OTO - NOTNLM
OT  - anti-CTLA-4
OT  - anti-PD1
OT  - anti-PDL1
OT  - immune checkpoint inhibitors
OT  - immune-related colitis
OT  - immune-related hepatitis
OT  - management
COIS- Conflict of interest statement: The authors declare that there is no conflict of 
      interest.
EDAT- 2019/11/15 06:00
MHDA- 2019/11/15 06:01
PMCR- 2019/11/05
CRDT- 2019/11/15 06:00
PHST- 2019/06/10 00:00 [received]
PHST- 2019/09/18 00:00 [accepted]
PHST- 2019/11/15 06:00 [entrez]
PHST- 2019/11/15 06:00 [pubmed]
PHST- 2019/11/15 06:01 [medline]
PHST- 2019/11/05 00:00 [pmc-release]
AID - 10.1177_1756284819884196 [pii]
AID - 10.1177/1756284819884196 [doi]
PST - epublish
SO  - Therap Adv Gastroenterol. 2019 Nov 5;12:1756284819884196. doi: 
      10.1177/1756284819884196. eCollection 2019.