1
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Townsend MJ, Benque IJ, Li M, Grover S. Review article: Contemporary management of gastrointestinal, pancreatic and hepatic toxicities of immune checkpoint inhibitors. Aliment Pharmacol Ther 2024; 59:1350-1365. [PMID: 38590108 DOI: 10.1111/apt.17980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/13/2023] [Accepted: 03/21/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) are effective oncologic agents which frequently cause immune-related adverse events (irAEs) which can impact multiple organ systems. Onco-Gastroenterology is a novel and emerging subspecialty within gastroenterology focused on cancer treatment-related complications. Gastroenterologists must be prepared to identify and manage diverse immune-mediated toxicities including enterocolitis, hepatitis, pancreatitis and other ICI-induced toxicities. AIM To provide a narrative review of the epidemiology, diagnostic evaluation and management of checkpoint inhibitor-induced gastrointestinal and hepatic toxicities. METHODS We searched Cochrane and PubMed databases for articles published through August 2023. RESULTS Gastrointestinal and hepatic irAEs include most commonly enterocolitis and hepatitis, but also pancreatitis, oesophagitis, gastritis, motility disorders (gastroparesis) and other rarer toxicities. Guidelines from the National Comprehensive Cancer Network, American Society of Clinical Oncology and European Society for Medical Oncology, in combination with emerging cohort and clinical trial data, offer strategies for management of ICI toxicities. Evaluation of irAEs severity by formal classification and clinical stability, and a thorough workup for alternative etiologies which may clinically mimic irAEs underlie initial management. Treatments include corticosteroids, biologics and other immunosuppressive agents plus supportive care; decisions on dosing, timing and choice of steroid adjuncts and potential for subsequent checkpoint inhibitor dosing are nuanced and toxicity-specific. CONCLUSIONS Expanding clinical trial and cohort data have clarified the epidemiology and clinical characteristics of gastrointestinal, pancreatic and hepatic toxicities of ICIs. Guidelines, though valuable, remain based principally on retrospective cohort data. Quality prospective, controlled studies may refine algorithms for treatment and potential immunotherapy rechallenge.
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Affiliation(s)
- Matthew J Townsend
- Department of Medicine, Duke University Hospital, Durham, North Carolina, USA
| | - Isaac J Benque
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Michael Li
- University of California San Francisco School of Medicine, San Francisco, California, USA
- Division of Gastroenterology, University of California San Francisco Medical Center, San Francisco, California, USA
| | - Shilpa Grover
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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2
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Tomm NK, Szczepanski JM, Fang JM, Choi WT, Xue Y, Setia N, Karamchandani DM, Cheng JY, Westerhoff M. Follow-up biopsies in gastrointestinal immune checkpoint inhibitor toxicity may show markedly different inflammatory patterns than initial injury. Hum Pathol 2024; 148:60-65. [PMID: 38734079 DOI: 10.1016/j.humpath.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/13/2024]
Abstract
Colitis is a common manifestation of immune checkpoint inhibitor (ICI) toxicity and can present with varied histologic patterns of inflammation, some of which have been shown to be associated with specific ICI drug types. Although the histologic features of ICI colitis seen at the time of diagnosis have been described, there have been few reports following these patients over time. We evaluated initial and follow-up biopsies in 30 patients with ICI colitis and found that 37% of patients developed a different pattern of injury on follow-up biopsy compared to the initial biopsy. Patients with a different inflammatory pattern were more likely to have restarted ICI therapy before their follow-up biopsy (64%) compared to those without a change in inflammatory pattern (11%; P < 0.01). The majority of these patients had changed ICI drug types (86%). Additionally, many cases changed to an inflammatory bowel disease (IBD)-like pattern (36%), raising a question of de novo IBD. However, all of our patients with an IBD-like pattern experienced sustained resolution of symptoms without steroids or other immunosuppressive medications following discontinuation of ICI therapy, consistent with a diagnosis of ICI toxicity. Our findings suggest that follow-up biopsies in patients with ICI colitis may show a different histology and that this does not necessarily warrant a change in the histologic diagnosis to another disease.
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Affiliation(s)
- Nicole K Tomm
- Department of Pathology, University of Michigan, 2800 Plymouth Road, NCRC Bldg 35, Ann Arbor, MI, 48109, USA.
| | - Julianne M Szczepanski
- Department of Pathology, University of Michigan, 2800 Plymouth Road, NCRC Bldg 35, Ann Arbor, MI, 48109, USA
| | - Jiayun M Fang
- Department of Pathology, University of Michigan, 2800 Plymouth Road, NCRC Bldg 35, Ann Arbor, MI, 48109, USA
| | - Won-Tak Choi
- Department of Pathology, University of California, San Francisco, 505 Parnassus Avenue, Suite M590, Box 0511, San Francisco, CA, 94143, USA
| | - Yue Xue
- Department of Pathology, Northwestern University Feinberg School of Medicine, 303 E. Chicago Ave., Ward 3-140, Chicago, IL, 60611, USA
| | - Namrata Setia
- Department of Pathology, University of Chicago, 5841 S. Maryland Ave., MC3083 - Rm. S329, Chicago, IL, 60637, USA
| | - Dipti M Karamchandani
- Department of Pathology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Jerome Y Cheng
- Department of Pathology, University of Michigan, 2800 Plymouth Road, NCRC Bldg 35, Ann Arbor, MI, 48109, USA
| | - Maria Westerhoff
- Department of Pathology, University of Michigan, 2800 Plymouth Road, NCRC Bldg 35, Ann Arbor, MI, 48109, USA
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3
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Fadlullah MZH, Lin CN, Coleman S, Young A, Naqash AR, Hu-Lieskovan S, Tan AC. Exploring the Landscape of Immune Checkpoint Inhibitor-Induced Adverse Events Through Big Data Mining of Pan-Cancer Clinical Trials. Oncologist 2024; 29:415-421. [PMID: 38330451 PMCID: PMC11067818 DOI: 10.1093/oncolo/oyae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/11/2024] [Indexed: 02/10/2024] Open
Abstract
PURPOSE Immune checkpoint inhibitors (ICIs) have significantly improved the survival of patients with cancer and provided long-term durable benefit. However, ICI-treated patients develop a range of toxicities known as immune-related adverse events (irAEs), which could compromise clinical benefits from these treatments. As the incidence and spectrum of irAEs differs across cancer types and ICI agents, it is imperative to characterize the incidence and spectrum of irAEs in a pan-cancer cohort to aid clinical management. DESIGN We queried >400 000 trials registered at ClinicalTrials.gov and retrieved a comprehensive pan-cancer database of 71 087 ICI-treated participants from 19 cancer types and 7 ICI agents. We performed data harmonization and cleaning of these trial results into 293 harmonized adverse event categories using Medical Dictionary for Regulatory Activities. RESULTS We developed irAExplorer (https://irae.tanlab.org), an interactive database that focuses on adverse events in patients administered with ICIs from big data mining. irAExplorer encompasses 71 087 distinct clinical trial participants from 343 clinical trials across 19 cancer types with well-annotated ICI treatment regimens and harmonized adverse event categories. We demonstrated a few of the irAE analyses through irAExplorer and highlighted some associations between treatment- or cancer-specific irAEs. CONCLUSION The irAExplorer is a user-friendly resource that offers exploration, validation, and discovery of treatment- or cancer-specific irAEs across pan-cancer cohorts. We envision that irAExplorer can serve as a valuable resource to cross-validate users' internal datasets to increase the robustness of their findings.
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Affiliation(s)
- Muhammad Zaki Hidayatullah Fadlullah
- Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Biomedical Informatics, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Ching-Nung Lin
- Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Biomedical Informatics, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Samuel Coleman
- Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Biomedical Informatics, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Arabella Young
- Department of Pathology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Abdul Rafeh Naqash
- Medical Oncology/TSET Phase 1 Program, Stephenson Cancer Center, The University of Oklahoma, Oklahoma City, OK, USA
| | - Siwen Hu-Lieskovan
- Division of Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Aik Choon Tan
- Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Biomedical Informatics, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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4
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Lan T, Yang WJ, Tong H. An Overlooked Cause of Severe Gastritis. Gastroenterology 2024; 166:e1-e4. [PMID: 37949247 DOI: 10.1053/j.gastro.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/01/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Tian Lan
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China; Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wen-Juan Yang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huan Tong
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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5
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Lin J, Lin ZQ, Zheng SC, Chen Y. Immune checkpoint inhibitor-associated gastritis: Patterns and management. World J Gastroenterol 2024; 30:1941-1948. [PMID: 38681126 PMCID: PMC11045486 DOI: 10.3748/wjg.v30.i14.1941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/23/2024] [Accepted: 03/28/2024] [Indexed: 04/12/2024] Open
Abstract
Immune checkpoint inhibitors (ICIs) are widely used due to their effectiveness in treating various tumors. Immune-related adverse events (irAEs) are defined as adverse effects resulting from ICI treatment. Gastrointestinal irAEs are a common type of irAEs characterized by intestinal side effects, such as diarrhea and colitis, which may lead to the cessation of ICIs. Although irAE gastritis is rarely reported, it may lead to serious complications such as gastrorrhagia. Furthermore, irAE gastritis is often difficult to identify early due to its diverse symptoms. Although steroid hormones and immunosuppressants are commonly used to reverse irAEs, the best regimen and dosage for irAE gastritis remains uncertain. In addition, the risk of recurrence of irAE gastritis after the reuse of ICIs should be considered. In this editorial, strategies such as early identification, pathological diagnosis, management interventions, and immunotherapy rechallenge are discussed to enable clinicians to better manage irAE gastritis and improve the prognosis of these patients.
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Affiliation(s)
- Jing Lin
- Department of Medical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350000, Fujian Province, China
| | - Zhong-Qiao Lin
- Phase I Clinical Trial Ward, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350000, Fujian Province, China
| | - Shi-Cheng Zheng
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou 350000, Fujian Province, China
| | - Yu Chen
- Department of Medical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350000, Fujian Province, China
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6
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Mitchell JM, Karamchandani DM. Histopathologic Manifestations of Immune Checkpoint Inhibitor Therapy-Associated Gastrointestinal Tract Injury: A Practical Review. Surg Pathol Clin 2023; 16:703-718. [PMID: 37863561 DOI: 10.1016/j.path.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Immune checkpoint inhibitors have revolutionized the management of many advanced cancers by producing robust remissions. They mostly target two immune regulatory pathways: cytotoxic T lymphocyte antigen-4 and programmed death-1 or its ligand. However, a flip side is the immune-related adverse events (irAEs) commonly affecting the gastrointestinal (GI) tract that can cause treatment interruptions or discontinuation. This practical review discusses the clinical and histopathologic findings of irAEs encountered in the luminal GI tract, along with histopathologic differentials that can mimic varied inflammatory, infectious, or other medication-associated etiologies and the importance of clinico-pathologic correlation for an accurate diagnosis.
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Affiliation(s)
- James Michael Mitchell
- Department of Pathology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA. https://twitter.com/GIJamesMD
| | - Dipti M Karamchandani
- Department of Pathology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
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Bresteau C, Bonnet P, Robert C, Mussini C, Saiag P, Buecher B, Lebbe C, Allez M, Benamouzig R, Hagège H, Bécheur H, Meyer A, Carbonnel F. Serious immune-related upper gastrointestinal toxicity of immune checkpoint inhibitors: a multicenter case series. J Gastroenterol Hepatol 2023; 38:2104-2110. [PMID: 37710354 DOI: 10.1111/jgh.16349] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 08/17/2023] [Accepted: 08/26/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICI) improve the prognosis of many cancers but cause immune-related adverse events (IrAEs). Limited data are available on upper gastrointestinal (UGI) IrAEs. We describe the clinical characteristics, prognosis, and efficacy of medical therapy in patients with UGI IrAEs. METHODS This is a retrospective, multicenter cohort study of patients with UGI symptoms and moderate to severe endoscopic UGI lesions, occurring after ICI. Efficacy of induction medical therapy and at the most recent follow-up was assessed. RESULTS Forty patients were included; of these, 34 (85%) received anti-PD(L)1, either alone (n = 24) or combined with anti CTLA-4 (n = 10). Eighteen patients (45%) had concomitant enterocolitis. All patients had severe endoscopic lesions (erosions, ulcerations, hemorrhage, or necrotic lesions). Three patients who received an inefficient initial medical treatment had a complicated course: One patient died of enterocolitis, one had a pneumomediastinum, and one developed an ulcerated stricture of the pylorus. Thirty-five patients (88%) were treated with corticosteroids; 28 patients (80%) responded, and 20 (57%) reached clinical remission. Eight patients were treated with infliximab, and six responded (75%). After a median follow-up of 11 months, 36 patients (90%) were in corticosteroid-free clinical remission for their UGI symptoms. Endoscopic lesions persisted in 68% of patients. CONCLUSIONS ICI cause severe UGI IrAEs, which are associated with enterocolitis in approximately half of the patients. Most patients with UGI IrAEs respond to corticosteroids or infliximab. These data support the recommendation to treat these patients without delay and in the same way as those with enterocolitis.
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Affiliation(s)
- Clément Bresteau
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin Bicêtre, France
- Université Paris-Saclay, Le Kremlin Bicêtre, France
| | - Pauline Bonnet
- Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Université Versailles Saint-Quentin-en-Yvelines, Boulogne-Billancourt, France
| | - Caroline Robert
- Université Paris-Saclay, Le Kremlin Bicêtre, France
- Institut Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Charlotte Mussini
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Philippe Saiag
- Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Université Versailles Saint-Quentin-en-Yvelines, Boulogne-Billancourt, France
| | - Bruno Buecher
- Institut Curie, PSL Research University, Départements de Génétique et d'Oncologie Médicale, Paris, France
| | - Celeste Lebbe
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, Université Paris Cité, Dermato-Oncology; INSERM U976, Paris, France
| | - Matthieu Allez
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, Université Paris Cité, Paris, France
| | - Robert Benamouzig
- Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Université Sorbonne Paris Nord, Bobigny, France
| | - Hervé Hagège
- Hôpital Intercommunal de Créteil, Hépato-Gastro-Entérologie, Créteil, France
| | - Hakim Bécheur
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Université Paris Cité, Paris, France
| | - Antoine Meyer
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin Bicêtre, France
- Université Paris-Saclay, Le Kremlin Bicêtre, France
| | - Franck Carbonnel
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin Bicêtre, France
- Université Paris-Saclay, Le Kremlin Bicêtre, France
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8
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Baarslag MA, Heimovaara JH, Borgers JSW, van Aerde KJ, Koenen HJPM, Smeets RL, Buitelaar PLM, Pluim D, Vos S, Henriet SSV, de Groot JWB, van Grotel M, Rosing H, Beijnen JH, Huitema ADR, Haanen JBAG, Amant F, Gierenz N. Severe Immune-Related Enteritis after In Utero Exposure to Pembrolizumab. N Engl J Med 2023; 389:1790-1796. [PMID: 37937778 DOI: 10.1056/nejmoa2308135] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Immune checkpoint blockade has become standard treatment for many types of cancer. Such therapy is indicated most often in patients with advanced or metastatic disease but has been increasingly used as adjuvant therapy in those with early-stage disease. Adverse events include immune-related organ inflammation resembling autoimmune diseases. We describe a case of severe immune-related gastroenterocolitis in a 4-month-old infant who presented with intractable diarrhea and failure to thrive after in utero exposure to pembrolizumab. Known causes of the symptoms were ruled out, and the diagnosis of pembrolizumab-induced immune-related gastroenterocolitis was supported by the results of histopathological assays, immunophenotyping, and analysis of the level of antibodies against programmed cell death protein 1 (PD-1). The infant's condition was successfully treated with prednisolone and infliximab.
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MESH Headings
- Humans
- Infant
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Enteritis/chemically induced
- Enteritis/diagnosis
- Enteritis/drug therapy
- Enteritis/immunology
- Neoplasms/drug therapy
- Antineoplastic Agents, Immunological/administration & dosage
- Antineoplastic Agents, Immunological/adverse effects
- Antineoplastic Agents, Immunological/therapeutic use
- Immune Checkpoint Inhibitors/administration & dosage
- Immune Checkpoint Inhibitors/adverse effects
- Immune Checkpoint Inhibitors/therapeutic use
- Failure to Thrive/chemically induced
- Failure to Thrive/immunology
- Diarrhea, Infantile/chemically induced
- Diarrhea, Infantile/immunology
- Gastroenteritis/chemically induced
- Gastroenteritis/diagnosis
- Gastroenteritis/drug therapy
- Gastroenteritis/immunology
- Enterocolitis/chemically induced
- Enterocolitis/diagnosis
- Enterocolitis/drug therapy
- Enterocolitis/immunology
- Programmed Cell Death 1 Receptor/immunology
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Affiliation(s)
- Manuel A Baarslag
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Joosje H Heimovaara
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Jessica S W Borgers
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Koen J van Aerde
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Hans J P M Koenen
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Ruben L Smeets
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Pauline L M Buitelaar
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Dick Pluim
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Shoko Vos
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Stefanie S V Henriet
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Jan Willem B de Groot
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Martine van Grotel
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Hilde Rosing
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Jos H Beijnen
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Alwin D R Huitema
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - John B A G Haanen
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Frédéric Amant
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Nicole Gierenz
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
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Terrin M, Migliorisi G, Dal Buono A, Gabbiadini R, Mastrorocco E, Quadarella A, Repici A, Santoro A, Armuzzi A. Checkpoint Inhibitor-Induced Colitis: From Pathogenesis to Management. Int J Mol Sci 2023; 24:11504. [PMID: 37511260 PMCID: PMC10380448 DOI: 10.3390/ijms241411504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
The advent of immunotherapy, specifically of immune checkpoint inhibitors (ICIs), for the treatment of solid tumors has deeply transformed therapeutic algorithms in medical oncology. Approximately one-third of patients treated with ICIs may de velop immune-related adverse events, and the gastrointestinal tract is often affected by different grades of mucosal inflammation. Checkpoint inhibitors colitis (CIC) presents with watery or bloody diarrhea and, in the case of severe symptoms, requires ICIs discontinuation. The pathogenesis of CIC is multifactorial and still partially unknown: anti-tumor activity that collaterally effects the colonic tissue and the upregulation of specific systemic inflammatory pathways (i.e., CD8+ cytotoxic and CD4+ T lymphocytes) are mainly involved. Many questions remain regarding treatment timing and options, and biological treatment, especially with anti-TNF alpha, can be offered to these patients with the aim of rapidly resuming oncological therapies. CIC shares similar pathogenesis and aspects with inflammatory bowel disease (IBD) and the use of ICI in IBD patients is under evaluation. This review aims to summarize the pathogenetic mechanism underlying CIC and to discuss the current evidenced-based management options, including the role of biological therapy, emphasizing the relevant clinical impact on CIC and the need for prompt recognition and treatment.
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Affiliation(s)
- Maria Terrin
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.T.); (G.M.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
| | - Giulia Migliorisi
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.T.); (G.M.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
| | - Arianna Dal Buono
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.T.); (G.M.)
| | - Roberto Gabbiadini
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.T.); (G.M.)
| | - Elisabetta Mastrorocco
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.T.); (G.M.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
| | - Alessandro Quadarella
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.T.); (G.M.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Medical Oncology and Haematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Alessandro Armuzzi
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.T.); (G.M.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
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Cijauskaite E, Kazenaite E, Strainiene S, Sadauskaite G, Kurlinkus B. Nivolumab-induced tumour-like gastritis: A case report. World J Clin Cases 2023; 11:4350-4359. [PMID: 37449232 PMCID: PMC10336988 DOI: 10.12998/wjcc.v11.i18.4350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/23/2023] [Accepted: 05/09/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitors are one of the modern treatment methods for advanced malignancies. However, this group of medications is also associated with various immune-related adverse events, such as colitis or pneumonitis. Immune checkpoint inhibitor-induced gastritis is a less common adverse event.
CASE SUMMARY We describe a 64-year-old woman presenting with diarrhea, nausea, and discomfort in the upper abdominal region. The patient had a history of metastatic lung cancer, which was treated with nivolumab. During the first endoscopy, an infiltrating gastric tumour was suspected. Later, based on endoscopic, histological and radiological findings, nivolumab-induced gastritis was diagnosed. The patient was successfully treated with three courses of omeprazole.
CONCLUSION As a consequence of the increased use of immune checkpoint inhibitors, a growing number of reported immune-related adverse events could be expected. The diagnosis of immune checkpoint inhibitor-induced gastritis should be considered when assessing a patient treated with nivolumab with upper gastrointestinal distress.
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Affiliation(s)
| | - Edita Kazenaite
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
- Vilnius University Hospital Santaros Clinics, Center of Hepatology, Gastroenterology and Dietology, Vilnius 08661, Lithuania
| | - Sandra Strainiene
- Department of Internal Medicine and Surgery, Antakalnis Clinic, Vilnius 10207, Lithuania
| | - Goda Sadauskaite
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
- Vilnius University Hospital Santaros Clinics, Center of Hepatology, Gastroenterology and Dietology, Vilnius 08661, Lithuania
| | - Benediktas Kurlinkus
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
- Vilnius University Hospital Santaros Clinics, Center of Hepatology, Gastroenterology and Dietology, Vilnius 08661, Lithuania
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Iwamuro M, Tanaka T, Kagawa S, Inoo S, Otsuka M. Collagenous Colitis in a Patient With Gastric Cancer Who Underwent Chemotherapy. Cureus 2023; 15:e39466. [PMID: 37378156 PMCID: PMC10292025 DOI: 10.7759/cureus.39466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
Herein, we present a case of collagenous colitis in a patient who underwent chemotherapy for gastric cancer, comprising five cycles of S-1 plus oxaliplatin and trastuzumab, followed by five cycles of paclitaxel and ramucirumab and seven cycles of nivolumab. The subsequent initiation of trastuzumab deruxtecan chemotherapy led to the development of grade 3 diarrhea after the second cycle of treatment. Collagenous colitis was diagnosed via colonoscopy and biopsy. The patient's diarrhea improved following the cessation of lansoprazole. This case highlights the importance of considering collagenous colitis as a differential diagnosis, in addition to chemotherapy-induced colitis and immune-related adverse event (irAE) colitis, in patients with similar clinical presentations.
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Affiliation(s)
- Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, JPN
| | - Takehiro Tanaka
- Department of Pathology, Okayama University Hospital, Okayama, JPN
| | - Shunsuke Kagawa
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, JPN
| | - Shoko Inoo
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, JPN
| | - Motoyuki Otsuka
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, JPN
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Alruwaii ZI, Montgomery EA. Gastrointestinal and Hepatobiliary Immune-related Adverse Events: A Histopathologic Review. Adv Anat Pathol 2023; 30:230-240. [PMID: 37037419 DOI: 10.1097/pap.0000000000000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Immune checkpoint inhibitors have been increasingly used to treat various malignant neoplasms. Despite their superior efficacy in treating certain ones, their global immune-activation effect leads to systemic side effects, referred to as immune-related adverse events. Immune-related adverse events affect a variety of organs, including the skin, gastrointestinal, hepatobiliary, and endocrine organs. Gastrointestinal tract immune-related adverse events present with a wide range of symptoms with variable severity, which may lead to treatment interruption and administration of immunosuppression therapy in many cases. Histopathologic changes are diverse, overlapping with many other conditions. Therefore, recognizing these changes is crucial in diagnosing immune-related adverse events. This review discusses the pathologic manifestations of gastrointestinal immune-related adverse events and discusses the primary differential diagnoses.
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13
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Boulagnon-Rombi C, Dufour C, Chatelain D. [Drug induced gastro-intestinal tract lesions: A pathologist point of view]. Ann Pathol 2023:S0242-6498(23)00045-7. [PMID: 36868901 DOI: 10.1016/j.annpat.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/31/2023] [Accepted: 02/08/2023] [Indexed: 03/05/2023]
Abstract
The number of drugs available to clinicians, especially targeted therapies, grows continuously. Some drugs are known to cause frequent digestive adverse effects, which may affect the gastro-intestinal tract in a diffuse or localized manner. Some treatments may leave relatively pathognomonic deposits, but histological lesions of iatrogenic origin are mostly non-specific. The diagnostic and etiological approach is often complex because of these non-specific aspects and also because (1) a single type of drug may cause different histological lesions, (2) different drugs may cause identical histological lesions, (3) the patient may receive different drugs, and (4) drug-induced lesions may mimic other pathological entities such as inflammatory bowel disease, celiac disease, or graft versus host disease. The diagnosis of iatrogenic gastrointestinal tract injury therefore requires close anatomic-clinical correlation. The iatrogenic origin can only be formally established if the symptomatology improves when the incriminating drug is stopped. This review aims to present the different histological patterns of gastrointestinal tract iatrogenic lesions, the potentially incriminate drugs, as well as the histological signs to look for in order to help the pathologist to distinguish an iatrogenic injury from another pathology of the gastrointestinal tract.
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Affiliation(s)
- Camille Boulagnon-Rombi
- Service de pathologie, centre hospitalier universitaire de Reims, 51092 Reims cedex, France; Université de Reims Champagne Ardenne, CNRS, MEDyC UMR 7369, 51097 Reims, France.
| | - Charlotte Dufour
- Institut de pathologie, centre de biologie pathologie, centre hospitalier universitaire de Lille, 59000 Lille, France
| | - Denis Chatelain
- Service d'anatomie pathologique du CHU d'Amiens, site Nord, 80080 Amiens, France
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14
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Drug-induced digestive tract injury: decoding some invisible offenders. Hum Pathol 2023; 132:135-148. [PMID: 35714837 DOI: 10.1016/j.humpath.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/09/2022] [Indexed: 02/07/2023]
Abstract
There is an ever-growing list of pharmacological agents, several of which are attributed to cause clinically significant gastrointestinal (GI) injury. Many patients present with significant but nonspecific symptoms, that in conjunction with the absence of relevant drug history on the requisition slip can make the histopathologic diagnosis challenging. To complicate this, although some drugs have relatively characteristic histopathologic features (such as doxycycline), there exist many other drugs that exhibit wide and varying spectra of histopathologic findings (such as immune checkpoint inhibitors or olmesartan) and have histomorphologic overlap with many other commonly encountered disease entities. This review discusses the histopathologic features of some relatively recently described drugs causing GI tract injury, namely doxycycline, tacrolimus, mycophenolate, immune checkpoint inhibitors, and olmesartan. We also discuss the common mimics in histopathologic differential and some pearls that can help distinguish GI tract injury induced by the aforementioned drugs from its mimics. Awareness of the wide spectra of histopathologic changes associated with these drugs is crucial for practicing pathologists, to avoid misdiagnosis and guiding the clinician for an optimal patient management, which usually involves modifying or discontinuing the offending drug. Needless to say, once a diagnosis of drug-induced injury is suspected, clinicopathologic correlation including corroboration with the drug history is of utmost importance as is the exclusion of dual pathology in these patients.
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15
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Haryal A, Townsend MJ, Baskaran V, Srivoleti P, Giobbie-Hurder A, Sack JS, Isidro RA, LeBoeuf NR, Buchbinder EI, Hodi FS, Grover S. Immune checkpoint inhibitor gastritis is often associated with concomitant enterocolitis, which impacts the clinical course. Cancer 2023; 129:367-375. [PMID: 36377339 DOI: 10.1002/cncr.34543] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Gastrointestinal immune-related adverse events are frequently caused by immune checkpoint inhibitors (ICIs) and often require interruption of cancer treatment. Compared with ICI colitis and enteritis, limited information exists about ICI gastritis. This study characterized clinical features and treatment outcomes of ICI gastritis. METHODS Consecutive cancer patients who received ICIs and underwent endoscopy with gastric biopsies while on ICIs from 2011 to 2021 were retrospectively assessed. Specific histopathologic features identified ICI gastritis. RESULTS Of 6450 ICI-treated patients, 162 (2.5%) underwent endoscopy with gastric biopsies. ICI gastritis was identified in 54 (33%) biopsied patients; 38 (70%) had concurrent ICI enteritis/colitis and 16 (30%) had isolated ICI gastritis. Dyspepsia (38%) and bloating (25%) were the most frequent symptoms of isolated ICI gastritis. Compared with patients with concomitant enteritis/colitis, patients with isolated gastritis were less likely to have diarrhea (13% vs 68%; p < .001) or abdominal pain (19% vs 47%; p = .07). Patients with isolated ICI gastritis less frequently required glucocorticoids (69% vs 92%; p = .04) and had lower incidence of ICI hold/withdrawal (13% vs 42%; p = .06). There was no association between severity or extent of luminal inflammation and antitumor response (p = .85 and p = .44, respectively). Endoscopically, gastric mucosa appeared normal in 11 (20%) patients with biopsy-proven ICI gastritis. CONCLUSION ICI gastritis may present alone or more commonly with concurrent enteritis/colitis, which may differentiate its clinical course. Gastric biopsies are required to diagnose a substantial minority of endoscopically normal, clinically significant cases. Most patients with isolated gastritis can continue ICI therapy uninterrupted, but a notable proportion require glucocorticoids. PLAIN LANGUAGE SUMMARY Immune checkpoint inhibitors are effective anticancer treatments, but can cause inflammatory toxicities, including of the stomach (gastritis), intestine, and colon. Limited information is available on gastritis triggered by these agents. Adult patients with cancer who were treated with immune checkpoint inhibitors and had an upper gastrointestinal endoscopy with biopsies of the stomach were examined. More than two-thirds (70%) of people with checkpoint inhibitor gastritis also had inflammatory changes of the small intestine and/or colon. Compared with patients with isolated checkpoint gastritis, the subgroup with concomitant enteritis/colitis more frequently had abdominal pain, diarrhea, needed steroids, and/or needed to pause or stop antitumor therapy.
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Affiliation(s)
- Aneesha Haryal
- Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Matthew J Townsend
- Department of Medicine, Duke University Hospital, Durham, North Carolina, USA
| | - Vinitha Baskaran
- Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Padmavathi Srivoleti
- Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Anita Giobbie-Hurder
- Division of Biostatistics, Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jordan S Sack
- Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Raymond A Isidro
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nicole R LeBoeuf
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Dermatology, Center for Cutaneous Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Elizabeth I Buchbinder
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - F Stephen Hodi
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Shilpa Grover
- Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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16
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Paredes-Ruiz D, López-López F, Núñez-Sobrino JA, Gómez-Martin C, Díaz-Pedroche C, Lizasoain M. [Cytomegalovirus reactivation in patients with immune-mediated gastritis]. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:298-300. [PMID: 36681573 DOI: 10.1016/j.eimce.2022.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/11/2022] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Reactivation of cytomegalovirus can complicate the evolution of patients with gastritis induced by immune checkpoint inhibitors. METHODS The experience in our center is described and a review of the literature is performed. RESULTS A case of severe gastritis induced by treatment with a programmed cell death receptor-1 (anti-PD1) inhibitor, associated with reactivation of cytomegalovirus (CMV) is described. In the systematic review, we identified 5 cases of immune-related gastritis associated with CMV reactivation. Ganciclovir treatment contributed to clinical improvement in most patients. CONCLUSION The early identification of a CMV infection in patients with severe or refractory immune-related gastritis will allow the initiation of targeted treatment, and may avoid increasing immunosuppressive therapy.
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Affiliation(s)
- Diana Paredes-Ruiz
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España.
| | - Flora López-López
- Servicio de Oncología Médica, Hospital Universitario 12 de Octubre, Madrid, España
| | | | - Carlos Gómez-Martin
- Servicio de Oncología Médica, Hospital Universitario 12 de Octubre, Madrid, España
| | - Carmen Díaz-Pedroche
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España
| | - Manuel Lizasoain
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Madrid, España
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17
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Wong CK, Lam TH, Liao SY, Lau YM, Tse HF, So BYF. Immunopathogenesis of Immune Checkpoint Inhibitor Induced Myocarditis: Insights from Experimental Models and Treatment Implications. Biomedicines 2023; 11:biomedicines11010107. [PMID: 36672615 PMCID: PMC9855410 DOI: 10.3390/biomedicines11010107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
Despite the extraordinary success of immune checkpoint inhibitors (ICIs) in cancer treatment, their use is associated with a high incidence of immune-related adverse events (IRAEs), resulting from therapy-related autoimmunity against various target organs. ICI-induced myocarditis is one of the most severe forms of IRAE, which is associated with risk of hemodynamic compromise and mortality. Despite increasing recognition and prompt treatment by clinicians, there remain significant gaps in knowledge regarding the pathophysiology, diagnosis and treatment of ICI-induced myocarditis. As the newly emerged disease entity is relatively rare, it is challenging for researchers to perform studies involving patients at scale. Alternatively, mouse models have been developed to facilitate research understanding of the pathogenesis of ICI-induced myocarditis and drug discovery. Transgenic mice with immune checkpoint genes knocked out allow induction of myocarditis in a highly reproducible manner. On the other hand, it has not been possible to induce ICI-induced myocarditis in wild type mice by injecting ICIs monotherapy alone. Additional interventions such as combinational ICI, tumor inoculation, cardiac sarcomere immunization, or cardiac irradiation are necessary to mimic the underlying pathophysiology in human cancer patients and to induce ICI-induced myocarditis successfully. This review focuses on the immunopathogenesis of ICI-induced myocarditis, drawing insights from human studies and animal models, and discusses the potential implications for treatment.
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Affiliation(s)
- Chun-Ka Wong
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Tsun-Ho Lam
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Song-Yan Liao
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Yee-Man Lau
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Hung-Fat Tse
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
- Hong Kong-Guangdong Stem Cell and Regenerative Medicine Research Centre, The University of Hong Kong and Guangzhou Institutes of Biomedicine and Health, Hong Kong SAR, China
- Centre for Stem Cell Translational Biology, Hong Kong SAR, China
| | - Benjamin Y. F. So
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Correspondence: ; Tel.: +852-2255-3111
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18
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Mommersteeg MC, Yu BT, van den Bosch TPP, von der Thüsen J, Kuipers EJ, Doukas M, Spaander M, Peppelenbosch MP, Fuhler GM. Constitutive programmed death ligand 1 expression protects gastric G-cells from Helicobacter pylori-induced inflammation. Helicobacter 2022; 27:e12917. [PMID: 35899973 PMCID: PMC9542424 DOI: 10.1111/hel.12917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/20/2022] [Accepted: 06/23/2022] [Indexed: 12/09/2022]
Abstract
INTRODUCTION Gastric intestinal metaplasia (GIM) is a premalignant lesion, highly associated with Helicobacter pylori infection. Previous studies have shown that H. pylori is able to induce the expression of programmed death ligand 1 (PD-L1), an inhibitory immune modulator, in gastric cells. Our aim was to investigate whether tissues from GIM patients may exploit PD-L1 expression upon H. pylori infection to evade immunosurveillance. METHODS Immunohistochemistry was performed for PD-L1 and enteroendocrine markers somatostatin and gastrin on samples derived from a cohort of patients with known GIM, both before and after H. pylori eradication. To determine the identity of any observed PD-L1-positive cells, we performed multiplex immunofluorescent staining and analysis of single-cell sequencing data. RESULTS GIM tissue was rarely positive for PD-L1. In normal glands from GIM patients, PD-L1 was mainly expressed by gastrin-positive G-cells. While the D-cell and G-cell compartments were both diminished 2-fold (p = .015 and p = .01, respectively) during H. pylori infection in the normal antral tissue of GIM patients, they were restored 1 year after eradication. The total number of PD-L1-positive cells was not affected by H. pylori, but the percentage of PD-L1-positive G-cells was 30% higher in infected subjects (p = .011), suggesting that these cells are preferentially rescued from destruction. CONCLUSIONS Antral G-cells frequently express PD-L1 during homeostasis. G-cells seem to be protected from H. pylori-induced immune destruction by PD-L1 expression. GIM itself does not express PD-L1 and is unlikely to escape immunosurveillance via expression of PD-L1.
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Affiliation(s)
- Michiel C. Mommersteeg
- Department of Gastroenterology and HepatologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Bing Ting Yu
- Department of Gastroenterology and HepatologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | | | | | - Ernst J. Kuipers
- Department of Gastroenterology and HepatologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Michael Doukas
- Department of PathologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Manon C. W. Spaander
- Department of Gastroenterology and HepatologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Maikel P. Peppelenbosch
- Department of Gastroenterology and HepatologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Gwenny M. Fuhler
- Department of Gastroenterology and HepatologyErasmus MC University Medical CenterRotterdamThe Netherlands
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19
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Immune checkpoint Inhibitor–Induced diarrhea and Colitis: Incidence and Management. A systematic review and Meta-analysis. Cancer Treat Rev 2022; 109:102440. [DOI: 10.1016/j.ctrv.2022.102440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 11/22/2022]
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20
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Clinical Characteristics and Outcomes of Gastritis Associated With Immune Checkpoint Inhibitors: Scoping Review. J Immunother 2022; 45:363-369. [PMID: 35972801 DOI: 10.1097/cji.0000000000000435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/30/2022] [Indexed: 11/25/2022]
Abstract
Among immune-related adverse events associated with immune checkpoint inhibitors, immune-mediated gastritis (IMG) has been rarely described in the literature and has not yet been well characterized. This scoping review aimed to characterize IMG in terms of precipitating agents, clinical presentations, and prognosis. After the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews, we searched MEDLINE and EMBASE for all peer-reviewed articles using keywords including "gastritis," "immune checkpoint inhibitor," and "immune-related adverse event" from their inception to December 28, 2021. Twenty-two articles, including 5 observational studies and 17 case reports and case series, were included. Nivolumab, pembrolizumab, and combination therapy with those and cytotoxic T-lymphocyte-associated antigen-4 inhibitor (ipilimumab) were commonly used in those with IMG. 59.8% had epigastric pain, and 50% had erosive gastritis. 87.5% had Common Terminology Criteria for Adverse Events (CTCAE) grade 3 gastritis, and 91.2% received corticosteroids. Recurrence was noted in 16.7%, and only 1 expiration was noted. 4.3% had positive helicobacter pylori and cytomegalovirus from the gastric specimen. Similar to immune-related colitis, patients with IMG may have a favorable prognosis with a better response to immune checkpoint inhibitors if treated appropriately. The diagnosis of IMG is made by exclusion, and a thorough workup is necessary to rule out concurrent helicobacter pylori and cytomegalovirus involvement. Further studies are critical for a better understanding of this complication.
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21
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Sugiyama Y, Tanabe H, Matsuya T, Kobayashi Y, Murakami Y, Sasaki T, Kunogi T, Takahashi K, Ando K, Ueno N, Kashima S, Moriichi K, Tanino M, Mizukami Y, Fujiya M, Okumura T. Severe immune checkpoint inhibitor-associated gastritis: A case series and literature review. Endosc Int Open 2022; 10:E982-E989. [PMID: 35845030 PMCID: PMC9286772 DOI: 10.1055/a-1839-4303] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/28/2022] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Recent advances in cancer treatment have involved the clinical application of immune checkpoint inhibitors (ICIs) for various type of cancers. The adverse events associated with ICIs are generally referred to as immune-related adverse events (irAEs). Gastrointestinal irAEs are a major disorder, but gastritis is not frequently observed. The aims of this study were to elucidate the clinical, endoscopic, and histological characteristics of irAE gastritis. Patients and methods Information on patients treated with ICIs were collected from a single institute over 3 years. IrAE gastritis was identified based on the clinical course and endoscopic and histopathological findings. Of the 359 patients treated with ICIs, four cases of irAE gastritis were identified in clinical records from the endoscopy unit. The endoscopic and histopathological findings were analyzed, and further immunohistochemical studies with immune subtype markers and programmed cell death ligand-1 (PD-L1) antibody were conducted. Results Among four patients with irAE gastritis, the remarkable endoscopic characteristics were network-pattern erosion, erythematous and edematous mucosa with thick purulent discharge, and fragile mucosa. Corresponding histological features were fibrinopurulent exudate, severe inflammatory cell infiltration, and epithalaxia, respectively. The PD-L1 expression rate was ≥ 1 % in the gastric tissue of all patients with gastritis. These patients were treated with prednisolone (PSL) and their symptoms improved within a few days to 2 weeks. Conclusions IrAE gastritis were characterized by specific endoscopic findings. The appropriate endoscopic diagnosis may lead to effective treatment with PSL.
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Affiliation(s)
- Yuya Sugiyama
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Hiroki Tanabe
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Taisuke Matsuya
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Yu Kobayashi
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Yuki Murakami
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Takahiro Sasaki
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Takehito Kunogi
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Keitaro Takahashi
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Katsuyoshi Ando
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Nobuhiro Ueno
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Shin Kashima
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Kentaro Moriichi
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Mishie Tanino
- Department of Diagnostic Pathology, Asahikawa Medical University Hospital, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Yusuke Mizukami
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Mikihiro Fujiya
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Toshikatsu Okumura
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
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22
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Alruwaii ZI, Montgomery EA. Gastrointestinal and Hepatobiliary Immune-related Adverse Events: A Histopathologic Review. Adv Anat Pathol 2022; 29:183-193. [PMID: 35470287 DOI: 10.1097/pap.0000000000000346] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Immune checkpoint inhibitors have been increasingly used to treat various malignant neoplasms. Despite their superior efficacy in treating certain ones, their global immune-activation effect leads to systemic side effects, referred to as immune-related adverse events. Immune-related adverse events affect a variety of organs, including the skin, gastrointestinal, hepatobiliary, and endocrine organs. Gastrointestinal tract immune-related adverse events present with a wide range of symptoms with variable severity, which may lead to treatment interruption and administration of immunosuppression therapy in many cases. Histopathologic changes are diverse, overlapping with many other conditions. Therefore, recognizing these changes is crucial in diagnosing immune-related adverse events. This review discusses the pathologic manifestations of gastrointestinal immune-related adverse events and discusses the primary differential diagnoses.
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23
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Paredes-Ruiz D, López-López F, Núñez-Sobrino JA, Gómez-Martin C, Díaz-Pedroche C, Lizasoain M. Reactivación de citomegalovirus en pacientes con gastritis inmunomediada. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Strong epidemiological evidence now exists that sex is an important biologic variable in immunity. Recent studies, for example, have revealed that sex differences are associated with the severity of symptoms and mortality due to coronavirus disease 2019 (COVID-19). Despite this evidence, much remains to be learned about the mechanisms underlying associations between sex differences and immune-mediated conditions. A growing body of experimental data has made significant inroads into understanding sex-influenced immune responses. As physicians seek to provide more targeted patient care, it is critical to understand how sex-defining factors (e.g., chromosomes, gonadal hormones) alter immune responses in health and disease. In this review, we highlight recent insights into sex differences in autoimmunity; virus infection, specifically severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection; and cancer immunotherapy. A deeper understanding of underlying mechanisms will allow the development of a sex-based approach to disease screening and treatment.
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Affiliation(s)
- Nicole M. Wilkinson
- UCLA/Caltech Medical Scientist Training Program, Los Angeles, California, USA
| | - Ho-Chung Chen
- Molecular Biology Institute, University of California, Los Angeles, California, USA
| | - Melissa G. Lechner
- Division of Endocrinology, Diabetes, and Metabolism, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Maureen A. Su
- Department of Microbiology, Immunology, and Molecular Genetics, David Geffen School of Medicine, University of California, Los Angeles, California, USA,Department of Pediatrics, David Geffen School of Medicine, University of Los Angeles, California, USA
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25
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Kikuchi H, Sakuraba H, Akemoto Y, Hosoi K, Murai Y, Hoshi K, Fukutoku Y, Asari T, Sawada Y, Hasui K, Tatsuta T, Hiraga H, Chinda D, Mikami T, Fukuda S. Endoscopic and histopathologic features of Anti‐PD‐1‐related collagenous colitis. DEN OPEN 2022; 2:e92. [PMID: 35310729 PMCID: PMC8828179 DOI: 10.1002/deo2.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/01/2021] [Accepted: 12/25/2021] [Indexed: 11/22/2022]
Abstract
Objectives Cancer patients treated with immune checkpoint inhibitors occasionally show persistent diarrhea accompanied by endoscopic features of ulcerative colitis. The endoscopic mucosal inflammation may appear mild in some patients compared to the clinical severity, which can make choosing a treatment challenging. In this study, we evaluated the factors that support the continuation of chemotherapy by assessing the endoscopic and histopathological characteristics of patients who experienced diarrhea after immune checkpoint inhibitor administration. Methods This study included eight patients who were diagnosed with collagenous colitis based on pathological assessments. We retrospectively investigated these patients’ backgrounds, laboratory data, and computed tomography images that were extracted from their medical records. We also summarized their endoscopic and pathologic findings. Results All eight patients were being treated with anti‐programmed cell death‐1/programmed cell death‐ligand 1 therapeutic agents and had a recent history of oral proton pump inhibitor therapy. The anti‐programmed cell death‐1‐related collagenous colitis in these cases was characterized by endoscopically mild mucosal inflammation, high fecal calprotectin levels, and a lower frequency of intestinal wall thickening on computed tomography. Histological assessments showed CD8+ lymphocytes predominantly infiltrating the lamina propria and crypts of the colonic mucosa. Suspending the proton pump inhibitor therapy relieved the patients’ symptoms and allowed the continuation of the anti‐programmed cell death‐1/programmed cell death‐ligand 1 therapy. Conclusions Anti‐programmed cell death‐1‐related collagenous colitis is reversible; appropriate diagnosis of adverse events is crucial for the continuation of immune checkpoint inhibitor therapy.
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Affiliation(s)
- Hidezumi Kikuchi
- Department of Gastroenterology and Hematology Hirosaki University Graduate School of Medicine Aomori Japan
- Department of Community Medicine Hirosaki University Graduate School of Medicine Aomori Japan
| | - Hirotake Sakuraba
- Department of Gastroenterology and Hematology Hirosaki University Graduate School of Medicine Aomori Japan
| | - Yui Akemoto
- Department of Anatomic Pathology Hirosaki University Hospital Aomori Japan
| | - Kazuhiro Hosoi
- Department of Pharmacy Hirosaki University Hospital Aomori Japan
| | - Yasuhisa Murai
- Department of Gastroenterology and Hematology Hirosaki University Graduate School of Medicine Aomori Japan
| | - Kentaro Hoshi
- Department of Gastroenterology and Hematology Hirosaki University Graduate School of Medicine Aomori Japan
| | - Yukari Fukutoku
- Department of Gastroenterology and Hematology Hirosaki University Graduate School of Medicine Aomori Japan
| | - Taka Asari
- Department of Gastroenterology and Hematology Hirosaki University Graduate School of Medicine Aomori Japan
| | - Yohei Sawada
- Department of Gastroenterology and Hematology Hirosaki University Graduate School of Medicine Aomori Japan
| | - Keisuke Hasui
- Department of Gastroenterology and Hematology Hirosaki University Graduate School of Medicine Aomori Japan
| | - Tetsuya Tatsuta
- Department of Gastroenterology and Hematology Hirosaki University Graduate School of Medicine Aomori Japan
| | - Hiroto Hiraga
- Department of Gastroenterology and Hematology Hirosaki University Graduate School of Medicine Aomori Japan
| | - Daisuke Chinda
- Department of Gastroenterology and Hematology Hirosaki University Graduate School of Medicine Aomori Japan
| | - Tatsuya Mikami
- Innovation Center for Health Promotion Hirosaki University Graduate School of Medicine Aomori Japan
| | - Shinsaku Fukuda
- Department of Gastroenterology and Hematology Hirosaki University Graduate School of Medicine Aomori Japan
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Parente P, Maiorano BA, Ciardiello D, Cocomazzi F, Carparelli S, Guerra M, Ingravallo G, Cazzato G, Carosi I, Maiello E, Bossa F. Clinic, Endoscopic and Histological Features in Patients Treated with ICI Developing GI Toxicity: Some News and Reappraisal from a Mono-Institutional Experience. Diagnostics (Basel) 2022; 12:diagnostics12030685. [PMID: 35328239 PMCID: PMC8947154 DOI: 10.3390/diagnostics12030685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/05/2022] [Accepted: 03/09/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Immune checkpoint inhibitors (ICIs) have widened the therapeutic scenario of different solid tumors over the last ten years. Gastrointestinal (GI) adverse events (AEs), such as diarrhea and colitis, occur in up to 50% of patients treated with ICIs. Materials and methods: We conducted a single-center retrospective analysis in patients with solid tumors treated with ICIs in a 6-year period, from 2015 to 2021, developing GI AEs, for which an endoscopic analysis was performed, with available histological specimens or surgery. Results: Twenty-one patients developed GI AEs under ICIs. The median time from the start of ICIs to the onset of GI AEs was 5 months. Diarrhea was the most frequent symptom (57.2%), upper GI symptoms presented in four patients (19%), while three patients (14.3%) had no symptoms and were diagnosed occasionally. Two patients underwent surgical resection for acute abdomen. Histological findings observed in endoscopic sampling were eosinophilic-pattern gastro-enterocolitis, apoptotic damage, IBD-like features, and ischemic-like changes. Histological damage was also documented in patients with unremarkable endoscopy. Conclusions: Under ICI therapy, GI toxicity is an expected event. Since GIAEs can mimic a broad range of primary GI diseases, a multidisciplinary approach is advocated with upper and lower GI mucosal sampling to remodel therapy and avoid complications.
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Affiliation(s)
- Paola Parente
- Pathology Unit, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, Viale Cappuccini 1, San Giovanni Rotondo, 71013 Foggia, Italy;
- Correspondence: (P.P.); (F.B.); Tel.: +390-8828-353910 (P.P. & F.B.); Fax: +390-8824-10411 (P.P. & F.B.)
| | - Brigida Anna Maiorano
- Oncology Unit, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71013 Foggia, Italy; (B.A.M.); (D.C.); (E.M.)
- Department of Translational Medicine and Surgery, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Davide Ciardiello
- Oncology Unit, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71013 Foggia, Italy; (B.A.M.); (D.C.); (E.M.)
- Oncology Unit, Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Francesco Cocomazzi
- Division of Gastroenterology, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, Viale Cappuccini 1, San Giovanni Rotondo, 71013 Foggia, Italy; (F.C.); (S.C.); (M.G.)
| | - Sonia Carparelli
- Division of Gastroenterology, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, Viale Cappuccini 1, San Giovanni Rotondo, 71013 Foggia, Italy; (F.C.); (S.C.); (M.G.)
| | - Maria Guerra
- Division of Gastroenterology, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, Viale Cappuccini 1, San Giovanni Rotondo, 71013 Foggia, Italy; (F.C.); (S.C.); (M.G.)
| | - Giuseppe Ingravallo
- Section of Molecular Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.I.); (G.C.)
| | - Gerardo Cazzato
- Section of Molecular Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.I.); (G.C.)
| | - Illuminato Carosi
- Pathology Unit, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, Viale Cappuccini 1, San Giovanni Rotondo, 71013 Foggia, Italy;
| | - Evaristo Maiello
- Oncology Unit, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71013 Foggia, Italy; (B.A.M.); (D.C.); (E.M.)
| | - Fabrizio Bossa
- Division of Gastroenterology, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, Viale Cappuccini 1, San Giovanni Rotondo, 71013 Foggia, Italy; (F.C.); (S.C.); (M.G.)
- Correspondence: (P.P.); (F.B.); Tel.: +390-8828-353910 (P.P. & F.B.); Fax: +390-8824-10411 (P.P. & F.B.)
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Checkpoint Inhibitors and Induction of Celiac Disease-like Condition. Biomedicines 2022; 10:biomedicines10030609. [PMID: 35327411 PMCID: PMC8945786 DOI: 10.3390/biomedicines10030609] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 12/13/2022] Open
Abstract
Immune checkpoint inhibitors herald a new era in oncological therapy-resistant cancer, thus bringing hope for better outcomes and quality of life for patients. However, as with other medications, they are not without serious side effects over time. Despite this, their advantages outweigh their disadvantages. Understanding the adverse effects will help therapists locate, apprehend, treat, and perhaps diminish them. The major ones are termed immune-related adverse events (irAEs), representing their auto-immunogenic capacity. This narrative review concentrates on the immune checkpoint inhibitors induced celiac disease (CD), highlighting the importance of the costimulatory inhibitors in CD evolvement and suggesting several mechanisms for CD induction. Unraveling those cross-talks and pathways might reveal some new therapeutic strategies.
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28
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Histological Features of Celiac-Disease-like Conditions Related to Immune Checkpoint Inhibitors Therapy: A Signal to Keep in Mind for Pathologists. Diagnostics (Basel) 2022; 12:diagnostics12020395. [PMID: 35204486 PMCID: PMC8871268 DOI: 10.3390/diagnostics12020395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/19/2022] [Accepted: 02/02/2022] [Indexed: 11/17/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) targeting cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), programmed cell death protein (PD-1), and its ligand PDL-1, are finding increasing application in the treatment of malignant neoplasms. The widespread clinical use of these drugs, however, resulted in the discovery of side effects. The occurrence of celiac disease (CD) after ICIs therapy has been reported in the literature, but its incidence remains unknown and the role of ICIs in its onset is not yet clear. In this review, we examine the published data on this topic in order to better understand and define this entity from a histological point of view. We performed an electronic literature search to identify original reports in which CD or pathological CD-like conditions were documented histologically in patients treated with ICIs. We identified ten papers. A total of twenty-five patients were included in these publications, eleven of them receiving a serologic and histological diagnosis of CD, and four a histological diagnosis of CD-like conditions, in which pathogenesis appears to be multifactorial. ICIs can cause a CD-like enteropathy and biopsies with clinical integration are crucial to diagnose this condition. CD rarely has been observed during treatment with ICIs and its morphological aspects are similar to ICIs-CD enteropathy. Moreover, the onset of ICIs-CD may have a distinct immune mechanism compared to classical CD. Thus, the pathologists must make a histological diagnosis of CD with caution and only in adequate clinical and serological context.
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Fuji S, Ohmoto A. Novel antibodies which have an impact on immune status after allogeneic hematopoietic cell transplantation. Expert Rev Hematol 2022; 15:45-51. [PMID: 35086410 DOI: 10.1080/17474086.2022.2035716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION In the field of hematological malignancy, we often have the opportunity to use antibodies such as immune checkpoint inhibitors that can alter a patient's immune status before or after allo-HCT. The appropriate use of these novel agents is highly necessary to optimize disease control and reduce the risk of complications associated with adverse allo-immune reactions. AREAS COVERED Clinical data on several monoclonal antibodies targeting programmed cell death 1 (PD-1) (nivolumab or pembrolizumab), C-C chemokine receptor 4 (CCR4) (mogamulizumab), CD30 (brentuximab vedotin), or cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) (ipilimumab) are reviewed, with a focus on the incidence and severity of graft-versus-host disease (GVHD). EXPERT OPINION While previous studies demonstrated a favorable prognosis in patients who received nivolumab prior to transplantation, the pretransplant use of nivolumab increases the incidence of GVHD, partly due to the expansion and activation of preexisting T cells. Mogamulizumab also has a significant impact on GVHD, caused by persistent depletion of regulatory T cells with CCR4 positivity. Regarding brentuximab vedotin, phase 1 trials have demonstrated considerable efficacy for steroid-refractory acute or chronic GVHD. In the future, sophisticated methods will be needed to determine the impact of each agent on immune status after allo-HCT.
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Affiliation(s)
- Shigeo Fuji
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
| | - Akihiro Ohmoto
- Department of Medical Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
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30
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Ai Q, Chen W, Li Y, Li G. Upper Gastrointestinal Tract IrAEs: A Case Report About Sintilimab-Induced Acute Erosive Hemorrhagic Gastritis. Front Immunol 2022; 13:840916. [PMID: 35720298 PMCID: PMC9204206 DOI: 10.3389/fimmu.2022.840916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/06/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Immune checkpoint inhibitors (ICIs) have now become the standard therapy for malignancies like non-small cell lung cancer and classical Hodgkin's lymphoma. ICIs are associated with unique immune-related adverse events (irAEs) caused by dysregulated immune activation. Treatment of lower gastrointestinal (GI) tract irAEs, such as colitis, is more common. However, for upper gastrointestinal tract irAEs, there is a lack of consensus in terms of globally standardized disease classification and treatment guidelines. Here, we report a case of sintilimab-induced acute erosive hemorrhagic gastritis. CASE PRESENTATION A 54-year-old man with metastatic NSCLC (PT2N2M1 stage IV) underwent treatment with eight courses of sintilimab + bevacizumab, followed by maintenance therapy with sintilimab alone. However, he presented with epigastric pain and melena at the end of the first sintilimab treatment, and the symptoms occurred repeatedly after regular treatment with acute erosive hemorrhagic gastritis. Repeat esophagogastroduodenoscopy (EGD) showed severe hemorrhagic gastritis; symptomatic relief and improvement in EGD images were noted for as long as he was being treated with steroids, methylprednisolone sodium. CONCLUSION As far as we are aware, we here describe the first case of sintilimab-associated acute erosive hemorrhagic gastritis, an upper gastrointestinal toxicity event. Throughout the treatment progression, differential diagnosis, multidisciplinary discussion, and the use of immunosuppressants were instrumental in clarifying the diagnosis and were crucial to the prognosis of the patient and continued treatment with ICIs.
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Kelly-Goss MR, Badran YR, Dougan M. Update on Immune Checkpoint Inhibitor Enterocolitis. Curr Gastroenterol Rep 2022; 24:171-181. [PMID: 36264425 PMCID: PMC9583048 DOI: 10.1007/s11894-022-00852-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Immune checkpoint inhibitor (ICI) therapy revolutionized the treatment of multiple solid and hematologic malignancies. Yet, with it came profound inflammatory toxicities that mimic autoimmune diseases, termed immune-related adverse events (irAEs). Prominent among these is gastrointestinal inflammation, including a spectrum of gastritis, enteritis, and colitis. Here we synthesize an approach to immune checkpoint related enterocolitis (irEC) - including diagnostics and therapeutics - underpinned by new insights into the mechanism behind these phenomena. RECENT FINDINGS This review presents updated insights on how to approach irEC, including novel approaches to selective immunosuppressive therapy, the role of fecal microbiota transplant, and the underlying cellular mechanisms of irEC. This review provides an update on irEC diagnosis and therapy, with considerations of new therapies and special patient populations. The field of gastrointestinal irAEs requires additional investigation, which will ultimately provide the tools required for patients to continue to receive life-saving ICI therapy.
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Affiliation(s)
- Molly R. Kelly-Goss
- Department of Medicine, Massachusetts General Hospital, Boston, MA 02114 USA ,Harvard Medical School, Boston, MA 02115 USA
| | - Yousef R. Badran
- Department of Medicine, Massachusetts General Hospital, Boston, MA 02114 USA ,Harvard Medical School, Boston, MA 02115 USA ,Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114 USA
| | - Michael Dougan
- Harvard Medical School, Boston, MA 02115 USA ,Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114 USA
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32
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Tang L, Wang J, Lin N, Zhou Y, He W, Liu J, Ma X. Immune Checkpoint Inhibitor-Associated Colitis: From Mechanism to Management. Front Immunol 2021; 12:800879. [PMID: 34992611 PMCID: PMC8724248 DOI: 10.3389/fimmu.2021.800879] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 11/29/2021] [Indexed: 02/05/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs), as one of the innovative types of immunotherapies, including programmed cell death-1 (PD-1), programmed cell death-ligand 1 (PD-L1), and cytotoxic T lymphocyte antigen 4 (CTLA-4) inhibitors, have obtained unprecedented benefit in multiple malignancies. However, the immune response activation in the body organs could arise immune-related adverse events (irAEs). Checkpoint inhibitor colitis (CIC) is the most widely reported irAEs. However, some obscure problems, such as the mechanism concerning gut microbiota, the confusing differential diagnosis with inflammatory bowel disease (IBD), the optimal steroid schedule, the reintroduction of ICIs, and the controversial prognosis features, influence the deep understanding and precise diagnosis and management of CIC. Herein, we based on these problems and comprehensively summarized the relevant studies of CIC in patients with NSCLC, further discussing the future research direction of this specific pattern of irAEs.
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Affiliation(s)
- Liansha Tang
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jialing Wang
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Nan Lin
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yuwen Zhou
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wenbo He
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jiyan Liu
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xuelei Ma
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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33
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Yanai S, Toya Y, Sugai T, Matsumoto T. Gastrointestinal Adverse Events Induced by Immune-Checkpoint Inhibitors. Digestion 2021; 102:965-973. [PMID: 34515105 DOI: 10.1159/000518543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/17/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND As immune-checkpoint inhibitors (ICI) are becoming standard therapies for malignant tumors, increasing attention has been paid to their associated immune-related adverse events (irAEs). The gastrointestinal tract is the major site of irAEs, and it has recently become evident that the large bowel is the most frequently affected region. The aim of this narrative review was to clarify the endoscopic and histopathologic findings of and treatments for ICI-induced colitis. SUMMARY Endoscopic findings of ICI-induced colitis include a reddish, edematous mucosa with increased mucous exudate, loss of normal vascularity, and a granular mucosa with or without mucosal breaks. Histopathologic findings of ICI-induced colitis are expansion of the lamina propria, intraepithelial infiltration of neutrophils, crypt architectural distortion, neutrophilic crypt abscess, and prominent apoptosis. The clinical, endoscopic, and histopathologic severity of ICI-induced colitis is diverse, but colonoscopy together with biopsy is necessary for diagnosis. While a certain proportion of patients with ICI-induced colitis have an intractable clinical course, management guidelines are based on retrospective analyses. Prospective studies are needed to assess the efficacy of various medications, including immunosuppressive regimens. Key Messages: Colonoscopy with biopsy is the gold standard for the diagnosis of ICI-induced colitis. Endoscopists should be aware of the clinical features and pathophysiology of ICI-induced colitis for prompt diagnosis and treatment planning.
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Affiliation(s)
- Shunichi Yanai
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Yosuke Toya
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Tamotsu Sugai
- Department of Diagnostic Pathology, Iwate Medical University, Morioka, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
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34
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Kuchroo JR, Hafler DA, Sharpe AH, Lucca LE. The double-edged sword: Harnessing PD-1 blockade in tumor and autoimmunity. Sci Immunol 2021; 6:eabf4034. [PMID: 34739340 DOI: 10.1126/sciimmunol.abf4034] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Juhi R Kuchroo
- Department of Immunology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA.,Evergrande Center for Immunological Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | - David A Hafler
- Departments of Neurology and Immunobiology, Yale School of Medicine, New Haven, CT, USA.,Broad Institute of MIT and Harvard University, Cambridge, MA, USA
| | - Arlene H Sharpe
- Department of Immunology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA.,Evergrande Center for Immunological Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA.,Broad Institute of MIT and Harvard University, Cambridge, MA, USA.,Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Liliana E Lucca
- Departments of Neurology and Immunobiology, Yale School of Medicine, New Haven, CT, USA
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35
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Sullivan RJ, Weber JS. Immune-related toxicities of checkpoint inhibitors: mechanisms and mitigation strategies. Nat Rev Drug Discov 2021; 21:495-508. [PMID: 34316029 DOI: 10.1038/s41573-021-00259-5] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 02/07/2023]
Abstract
The immune-related adverse events associated with treatment with immune checkpoint inhibitors result in significant morbidity for patients as well as considerable cost to the health-care system, and can limit the use of these beneficial drugs. Understanding the mechanisms of these side effects and how they can be separated from the antitumour effects of immune checkpoint inhibitors, as well as identifying biomarkers that predict the development of immune-related toxicities, will facilitate the conduct of trials to limit their onset and improve patient outcomes. In this Review, we discuss the different types of immune-related adverse events and how their treatment and identification of possible predictive biomarkers may shed light on their mechanisms, and describe possible strategies and targets for prophylactic and therapeutic intervention to mitigate them.
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Affiliation(s)
- Ryan J Sullivan
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey S Weber
- Laura and Isaac Perlmutter Comprehensive Cancer Center, NYU Grossman School of Medicine, New York, NY, USA.
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36
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Omotehara S, Nishida M, Yamanashi K, Sakurai K, Katsurada T, Komatsu Y, Shimizu A, Shibuya H, Shinagawa N, Sugita J, Teshima T. A case of immune checkpoint inhibitor-associated gastroenteritis detected by ultrasonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:605-609. [PMID: 33580597 DOI: 10.1002/jcu.22975] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 12/15/2020] [Accepted: 01/06/2021] [Indexed: 06/12/2023]
Abstract
While immune checkpoint inhibitors (ICIs) have antitumor effects, they also have characteristic side effects, including colitis. However, gastritis has rarely been reported. We report a case of a patient with lung adenocarcinoma who presented with epigastric pain and diarrhea following pembrolizumab administration. Sonography of the abdomen demonstrated diffuse, although mild, gastric wall thickening (mainly in the submucosa), as well as a slight decrease in echogenicity throughout the gastric wall. While the mucosal surface was relatively smooth, color Doppler examination showed increased vascularity. Esophagogastroduodenoscopy and pathological examination confirmed the diagnosis of ICI-related gastroenteritis.
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Affiliation(s)
- Satomi Omotehara
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Mutsumi Nishida
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Kana Yamanashi
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan
| | - Kensuke Sakurai
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan
| | | | | | - Ai Shimizu
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - Hitoshi Shibuya
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Naofumi Shinagawa
- Department of Respiratory Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Junichi Sugita
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
- Department of Hematology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takanori Teshima
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
- Department of Hematology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Ebisutani N, Tozawa K, Matsuda I, Nakamura K, Tamura A, Hara K, Kondo T, Terada T, Tomita T, Oshima T, Fukui H, Hirota S, Miwa H. A Case of Severe Acute Gastritis as an Immune-Related Adverse Event After Nivolumab Treatment: Endoscopic and Pathological Findings in Nivolumab-Related Gastritis. Dig Dis Sci 2021; 66:2461-2465. [PMID: 32780186 DOI: 10.1007/s10620-020-06529-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/30/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Nobuhiko Ebisutani
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, l-1, Mukogawa, Nishinomiya, 663-8501, Japan
| | - Katsuyuki Tozawa
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, l-1, Mukogawa, Nishinomiya, 663-8501, Japan
| | - Ikuo Matsuda
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kumiko Nakamura
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, l-1, Mukogawa, Nishinomiya, 663-8501, Japan
| | - Akio Tamura
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, l-1, Mukogawa, Nishinomiya, 663-8501, Japan
| | - Ken Hara
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, l-1, Mukogawa, Nishinomiya, 663-8501, Japan
| | - Takashi Kondo
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, l-1, Mukogawa, Nishinomiya, 663-8501, Japan
| | - Tomonori Terada
- Department of Otolaryngology - Head and Neck Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Toshihiko Tomita
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, l-1, Mukogawa, Nishinomiya, 663-8501, Japan
| | - Tadayuki Oshima
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, l-1, Mukogawa, Nishinomiya, 663-8501, Japan
| | - Hirokazu Fukui
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, l-1, Mukogawa, Nishinomiya, 663-8501, Japan
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroto Miwa
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, l-1, Mukogawa, Nishinomiya, 663-8501, Japan.
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Pisuchpen N, Durbin SM, Mooradian MJ, Fintelmann FJ, Reynolds KL, Dougan M, Kambadakone A. Multi-detector computed tomography (MDCT)-based severity score as a prognostic tool in patients with suspected immune checkpoint inhibitor therapy associated colitis. Eur Radiol 2021; 31:8868-8878. [PMID: 34081152 DOI: 10.1007/s00330-021-07925-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/15/2021] [Accepted: 03/23/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to assess MDCT as a diagnostic and prognostic tool in patients with suspected immune checkpoint inhibitor (ICI)-related colitis. MATERIALS AND METHODS This retrospective cohort study included patients receiving ICIs at three hospitals between 2015 and 2019 who underwent both abdominopelvic MDCT and endoscopic biopsy to workup suspected ICI-related colitis. Two radiologists independently reviewed MDCT images for signs of colitis based on pre-defined features. Diagnostic performance of MDCT was calculated and categorical variables between treatment subgroups were compared. Logistic regression was used to develop proposed MDCT criteria for diagnosis and MDCT severity score based on a combination of MDCT features of colitis to predict the patient outcomes in ICI-related colitis. RESULTS A total of 118 MDCT scans from 108 patients were evaluated for suspected colitis, with 72 confirmed ICI-related colitis cases. Sensitivity, specificity, PPV, and NPV of MDCT for diagnosis of ICI-related colitis was 81% (58/72), 52 % (24/46), 73% (58/80), and 63% (24/38), respectively. Small bowel involvement was visualized in 25% of cases with ICI-related colitis (18/72). In melanoma patients presenting with diarrhea grade ≥ 2 (n = 40), MDCT had the best diagnostic performance for ICI-related colitis (specificity = 80% [8/10], PPV = 92% [23/25]). MDCT severity scores predicted intravenous steroid use (OR 10.3, p = 0.004), length of stay > 7 days (OR 9.0, p < 0.001), and endoscopic mucosal ulceration (OR 4.7, p = 0.02). CONCLUSION MDCT is a useful diagnostic and prognostic tool for evaluating patients with immune checkpoint inhibitor-related colitis. An MDCT-based severity score enables assessment of disease severity and predicts outcome. KEY POINTS • MDCT is useful for the diagnosis of colitis in patients receiving immune checkpoint inhibitor (ICI) therapy, and an MDCT-based severity score allows for prognostication of patient outcomes. • MDCT yielded moderate sensitivity (81%) for diagnosis of ICI-related colitis but limited specificity (52%). However, in symptomatic melanoma patients (grade 2-4 diarrhea) with a high pretest probability, MDCT proved useful for diagnosis with a high PPV (92%). • For ICI-related colitis, our proposed MDCT severity score has prognostic value in predicting intravenous steroid use, prolonged length of stay during inpatient admission (> 7 days), and endoscopic mucosal ulceration.
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Affiliation(s)
- Nisanard Pisuchpen
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA.,Department of Radiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Sienna M Durbin
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Meghan J Mooradian
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Florian J Fintelmann
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Kerry L Reynolds
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Michael Dougan
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA.
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Patil PA, Zhang X. Pathologic Manifestations of Gastrointestinal and Hepatobiliary Injury in Immune Checkpoint Inhibitor Therapy. Arch Pathol Lab Med 2021; 145:571-582. [PMID: 32338534 DOI: 10.5858/arpa.2020-0070-ra] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2020] [Indexed: 02/05/2023]
Abstract
CONTEXT.— Immune checkpoint inhibitors (CPIs), including cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) inhibitors and the programmed death receptor-1 (PD-1)/programmed death ligand-1 (PD-L1) inhibitors, are being increasingly used for treating many advanced malignancies. However, CPI therapy is also associated with gastrointestinal and hepatobiliary adverse effects. OBJECTIVES.— To review the adverse effects of CPI therapy on the gastrointestinal tract and hepatobiliary system. To describe histopathologic patterns and discuss differential diagnostic considerations in the diagnosis of CPI injuries. DATA SOURCES.— Published peer-reviewed literature in the English language and personal experience in the diagnosis of CPI injuries. CONCLUSIONS.— The pathologic manifestations of CPI therapy-induced gastrointestinal and hepatobiliary injury are broad. The patterns of esophageal CPI injury include lymphocytic inflammation and ulcerative esophagitis, while those of gastric injury include chronic active gastritis, lymphocytic gastritis, focal enhancing gastritis, and periglandular inflammation. The duodenal injury may present as duodenitis with villous blunting and granulomas. We also noticed active colitis, microscopic colitis, chronic active colitis, increased apoptosis, ischemic colitis, and nonspecific inflammatory reactive changes in colonic injuries. The reported histologic features of hepatobiliary injuries are panlobular hepatitis, centrilobular necrosis, portal inflammation with bile duct injury, steatosis, nodular regenerative hyperplasia, and secondary sclerosing cholangitis. In summary, we discuss the pathologic features and differential diagnosis of CPI therapy-induced gastrointestinal and hepatobiliary injury. Recognition of CPI injury is important to determine the proper management that often includes cessation of CPI therapy, and administration of steroids or other immunosuppressive agents, based on severity of injury.
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Affiliation(s)
- Pallavi A Patil
- From the Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Xuchen Zhang
- From the Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
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Badran YR, Shih A, Leet D, Mooradian MJ, Coromilas A, Chen J, Kem M, Zheng H, Borowsky J, Misdraji J, Mino-Kenudson M, Dougan M. Immune checkpoint inhibitor-associated celiac disease. J Immunother Cancer 2021; 8:jitc-2020-000958. [PMID: 32581063 PMCID: PMC7319774 DOI: 10.1136/jitc-2020-000958] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Rare cases of immune checkpoint inhibitor (ICI)-associated celiac disease (ICI-CeD) have been reported, suggesting that disruption of tolerance mechanisms by ICIs can unmask celiac disease (CeD). This study aims to characterize the clinicopathological and immunophenotypic features of ICI-CeD in comparison to ICI-associated duodenitis (ICI-Duo) and usual CeD. METHODS A medical and pathological records search between 2015 and 2019 identified eight cases of ICI-CeD, confirmed by tTG-IgA. Nine cases of ICI-Duo, 28 cases of moderate CeD, as well as 5 normal controls were used as comparison groups. Clinical information was collected from the electronic medical records. Immunohistochemistry for CD3, CD8, T-cell receptor gamma/delta (γδ), programmed death ligand 1 (PD-L1), and programmed death 1 (PD-1) were performed, with quantification of intraepithelial lymphocyte (IEL) subsets in three well-oriented villi. CD68, PD-L1, and PD-1 were assessed as a percentage of lamina propria surface area infiltrated by positive cells. Statistical significance was calculated by the Student's t-test and Fisher's exact test. RESULTS The eight patients with ICI-CeD (F:M=1:3) and nine patients with ICI-Duo (F:M=5:4) presented similarly with diarrhea (13/17) and abdominal pain (11/17) after a median of 1.6 months on ICI therapy. In patients with ICI-CeD, tTG-IgA ranged from 104 to >300 IU/mL. Histological findings in ICI-CeD and ICI-Duo were similar and included expansion of the lamina propria, active neutrophilic duodenitis, variably increased IELs, and villous blunting. Immunohistochemistry showed that the average number of IELs per 100 enterocytes is comparable between ICI-CeD and ICI-Duo, with increased CD3+ CD8+ T cells compared with normal duodenum but decreased γδ T cells compared with CeD. Average PD-L1 percentage was 9% in ICI-CeD and 18% in ICI-Duo, in comparison to <1% in CeD and normal duodenum; average PD-1 percentage was very low to absent in all cases (<3%). On follow-up, five patients with ICI-CeD improved on a gluten-free diet (GFD) as the sole therapeutic intervention (with down-trending tTG-IgA) while the other three required immunosuppression. All patients who developed ICI-Duo received immunosuppression with variable improvement in symptoms. CONCLUSIONS ICI-CeD resembles ICI-Duo clinically and histologically but shares the serological features and response to gluten withdrawal with classic CeD. Immunophenotyping of IELs in ICI-CeD and ICI-Duo also shows similar CD3, CD8, γδ T cell subsets, and PD-L1 populations, all of which differed quantitatively from usual CeD. We conclude that ICI-CeD is biologically similar to ICI-Duo and is likely a variant of ICI-Duo, but treatment strategies differ, with ICI-CeD often improving with GFD alone, whereas ICI-Duo requires systemic immunosuppression.
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Affiliation(s)
- Yousef R Badran
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, MA, USA
| | - Angela Shih
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Meghan J Mooradian
- Harvard Medical School, Boston, MA, USA.,Division of Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Jonathan Chen
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marina Kem
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hui Zheng
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer Borowsky
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joseph Misdraji
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mari Mino-Kenudson
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael Dougan
- Harvard Medical School, Boston, MA, USA .,Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Zhang ML, Deshpande V. Histopathology of Gastrointestinal Immune-related Adverse Events: A Practical Review for the Practicing Pathologist. Am J Surg Pathol 2021; 46:e15-e26. [PMID: 33999556 DOI: 10.1097/pas.0000000000001730] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Immune checkpoint inhibitors target checkpoint proteins with the goal of reinvigorating the host immune system and thus restoring antitumor response. With the dramatic increase in the use of checkpoint inhibitors for cancer treatment, surgical pathologists have assumed a major role in predicting the therapeutic efficacy (score based on programmed cell death ligand 1 immunohistochemistry and mismatch repair protein loss) as well as diagnosing the complications associated with these medications. Immune-related adverse events (irAEs) manifest as histologic changes seen in both the upper and lower gastrointestinal tract, and when viewed in isolation, may be morphologically indistinguishable from a wide range of diseases including infections, celiac disease, and inflammatory bowel disease, among others. Evaluation of biopsies from both the upper and lower gastrointestinal tract can aid in the distinction of gastrointestinal irAEs from their mimics. In the liver, the histologic changes of hepatic irAEs overlap with de novo diseases associated with hepatitic and cholangitic patterns of injury. The diagnosis of irAEs requires communication and collaboration from the pathologist, oncologist, and gastroenterologist. This review provides a background framework and illustrates the histologic features and differential diagnosis of gastrointestinal and hepatic irAEs.
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Affiliation(s)
- M Lisa Zhang
- Department of Pathology, Massachusetts General Hospital Harvard Medical School, Boston, MA
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Shimozaki K, Hirata K, Horie S, Chida A, Tsugaru K, Hayashi Y, Kawasaki K, Miyanaga R, Hayashi H, Mizuno R, Funakoshi T, Hosoe N, Hamamoto Y, Kanai T. The Entire Intestinal Tract Surveillance Using Capsule Endoscopy after Immune Checkpoint Inhibitor Administration: A Prospective Observational Study. Diagnostics (Basel) 2021; 11:diagnostics11030543. [PMID: 33803735 PMCID: PMC8003297 DOI: 10.3390/diagnostics11030543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Despite the proven efficacy of immune checkpoint inhibitors (ICIs) against various types of malignancies, they have been found to induce immune-related adverse events, such as enterocolitis; however, the clinical features of ICI-induced enterocolitis remain to be sufficiently elucidated, which is significant, considering the importance of early detection in the appropriate management and treatment of ICI-induced enterocolitis. Therefore, the current study aimed to determine the utility of capsule endoscopy as a screening tool for ICI-induced enterocolitis. METHODS This single-center, prospective, observational study was conducted on patients with malignancy who received any ICI between April 2016 and July 2020 at Keio University Hospital. Next, second-generation capsule endoscopy (CCE-2) was performed on day 60 after ICI initiation to explore the entire gastrointestinal tract. RESULTS Among the 30 patients enrolled herein, 23 underwent CCE-2. Accordingly, a total of 23 findings were observed in 14 (60.8%) patients at any portion of the gastrointestinal tract (7 patients in the colon, 4 patients in the small intestine, 2 patients in both the colon and the small intestine, and 1 patient in the stomach). After capsule endoscopy, 2 patients (8.7%) developed ICI-induced enterocolitis: both had significantly higher Capsule Scoring of Ulcerative Colitis than those who had not developed ICI-induced enterocolitis (p = 0.0455). No adverse events related to CCE-2 were observed. CONCLUSIONS CCE-2 might be a safe and useful entire intestinal tract screening method for the early detection of ICI-induced enterocolitis in patients with malignancies.
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Affiliation(s)
- Keitaro Shimozaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.S.); (S.H.); (A.C.); (K.T.); (Y.H.); (K.K.); (R.M.); (T.K.)
| | - Kenro Hirata
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.S.); (S.H.); (A.C.); (K.T.); (Y.H.); (K.K.); (R.M.); (T.K.)
- Correspondence: ; Tel.: +81-3-3353-1211
| | - Sara Horie
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.S.); (S.H.); (A.C.); (K.T.); (Y.H.); (K.K.); (R.M.); (T.K.)
| | - Akihiko Chida
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.S.); (S.H.); (A.C.); (K.T.); (Y.H.); (K.K.); (R.M.); (T.K.)
| | - Kai Tsugaru
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.S.); (S.H.); (A.C.); (K.T.); (Y.H.); (K.K.); (R.M.); (T.K.)
| | - Yukie Hayashi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.S.); (S.H.); (A.C.); (K.T.); (Y.H.); (K.K.); (R.M.); (T.K.)
| | - Kenta Kawasaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.S.); (S.H.); (A.C.); (K.T.); (Y.H.); (K.K.); (R.M.); (T.K.)
| | - Ryoichi Miyanaga
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.S.); (S.H.); (A.C.); (K.T.); (Y.H.); (K.K.); (R.M.); (T.K.)
| | - Hideyuki Hayashi
- Keio Cancer Center, Keio University School of Medicine, Tokyo 160-8582, Japan; (H.H.); (Y.H.)
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo 160-8582, Japan;
| | - Takeru Funakoshi
- Department of Dermatology, Keio University School of Medicine, Tokyo 160-8582, Japan;
| | - Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo 160-8582, Japan;
| | - Yasuo Hamamoto
- Keio Cancer Center, Keio University School of Medicine, Tokyo 160-8582, Japan; (H.H.); (Y.H.)
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.S.); (S.H.); (A.C.); (K.T.); (Y.H.); (K.K.); (R.M.); (T.K.)
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Wang H, Cao F, Yang J, Wu Y, Wang L. The Clinical Value of Multislice Spiral Computed Tomography in the Diagnosis of Upper Digestive Tract Diseases. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6673712. [PMID: 33815731 PMCID: PMC7990549 DOI: 10.1155/2021/6673712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/01/2021] [Accepted: 03/08/2021] [Indexed: 12/19/2022]
Abstract
Imaging methods for gastrointestinal diseases were based on X-ray imaging until the 1970s, but the development of fiberoptic endoscopy in the 1980s has replaced X-ray imaging. Endoscopy can directly observe the location, size, scope, and color of lesions and obtain pathological results through biopsy, while ligation and other treatments can be performed on polyps and other lesions. Studies have shown that multilayer spiral computed tomography (CT) examination after standardized gastrointestinal preparation and full use of the advantages of various 3D postprocessing reconstruction techniques are of great clinical value in the detection of gastrointestinal diseases, determination of the nature of lesions, localization of lesions, and staging of gastrointestinal malignancies and can make up for the shortcomings of fiberoptic endoscopy, and various 3D postprocessing reconstruction modes have their own advantages and disadvantages. Among them, conventional CT cross-sectional images are the basic images for the diagnosis of various gastric testicular lesions. Axial images, especially thin-layer axial images, can detect the absolute majority of lesions, but there are limitations in observing the anatomical position of lesions, invasion of surrounding tissues, lymph node metastasis, vascularity, and determination of the stage of malignant tumors.
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Affiliation(s)
- Huali Wang
- School of Mathematics and Statistics, Hubei University of Arts and Science, Xiangyang, Hubei 441000, China
| | - Feng Cao
- Department of Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei 441000, China
| | - Jiaqi Yang
- Medical College of China Three Gorges University, Yichang, Hubei 443002, China
| | - Yongjuan Wu
- Department of Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei 441000, China
| | - Lin Wang
- Department of Gastroenterology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, China
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Irshaid L, Robert ME, Zhang X. Immune Checkpoint Inhibitor-Induced Upper Gastrointestinal Tract Inflammation Shows Morphologic Similarities to, but Is Immunologically Distinct From, Helicobacter pylori Gastritis and Celiac Disease. Arch Pathol Lab Med 2021; 145:191-200. [PMID: 33501492 DOI: 10.5858/arpa.2019-0700-oa] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 02/05/2023]
Abstract
CONTEXT.— Immune checkpoint inhibitor (CPI) therapies are associated with multi-organ immune-related adverse events. Although colonic mucosal changes have been described, inflammatory changes incited by CPIs in the upper gastrointestinal tract have not been well characterized. OBJECTIVE.— To investigate morphologic and immunologic changes incited by CPI therapy in the upper gastrointestinal tract. DESIGN.— We compared the morphology and immune cell phenotype of gastric and duodenal biopsies from patients treated with anti-cytotoxic T-lymphocyte associated protein 4 (CTLA-4) or anti-programmed death receptor-1/programmed death ligand-1 (PD-1/PD-L1) antibodies with biopsies from patients with Helicobacter pylori gastritis, patients with celiac disease, and normal controls. RESULTS.— Gastric biopsies from patients on CPIs showed chronic gastritis mimicking H pylori gastritis. However, CPI gastritis demonstrated greater numbers of CD8+ intraepithelial lymphocytes, less lamina propria inflammation, fewer plasma cells and CD20+ B cells, fewer lymphoid aggregates, and reduced CD4:CD8 ratio in both the lamina propria and the epithelial layer. There were no differences between anti-CTLA-4 and anti-PD-1/PD-L1 gastritis, except for more lymphoid aggregates in anti-PD-1/PD-L1 gastritis. Duodenal biopsies from patients on CPIs revealed chronic duodenitis with villous blunting, mimicking celiac disease. Compared with celiac disease, CPI duodenitis demonstrated higher prevalence of neutrophilic infiltrates and erosions, increased lamina propria CD3 and CD8 T cells, and reduced CD4:CD8 ratio. Upper gastrointestinal biopsies were more inflamed than concomitant colonic biopsies in the majority of patients. CONCLUSIONS.— The morphologic and immunophenotypic distinctions between CPI-associated upper gastrointestinal injuries and common infectious and autoimmune diseases may provide useful discriminators when clinicians are confronted with gastric and duodenal inflammatory changes in patients receiving CPI therapy.
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Affiliation(s)
- Lina Irshaid
- From the Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Marie E Robert
- From the Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Xuchen Zhang
- From the Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
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Dougan M, Wang Y, Rubio-Tapia A, Lim JK. AGA Clinical Practice Update on Diagnosis and Management of Immune Checkpoint Inhibitor Colitis and Hepatitis: Expert Review. Gastroenterology 2021; 160:1384-1393. [PMID: 33080231 DOI: 10.1053/j.gastro.2020.08.063] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/17/2020] [Accepted: 08/23/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Immune checkpoint inhibitors (ICIs) have transformed the treatment landscape for oncology, leading to durable remissions in a subset of patients, but also a broad range of potentially life-threatening inflammatory toxicities, many of which involve the gastrointestinal (GI) tract and liver. The purpose of this expert review was to update gastroenterologists on the gastrointestinal and hepatic toxicities of ICIs and provide best practice advice on their diagnosis and management. METHODS The evidence reviewed in this work combines the expert clinical opinion of the authors with a comprehensive search of several English-language databases and a manual review of relevant publications.
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Affiliation(s)
- Michael Dougan
- Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Yinghong Wang
- Division of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alberto Rubio-Tapia
- Division of Gastroenterology, Hepatology, and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joseph K Lim
- Yale Liver Center and Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut
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Ju JY, Stelow EB, Courville EL. Normal gastrointestinal tract inflammatory cells and review of select benign hematolymphoid proliferations. Semin Diagn Pathol 2021; 38:6-13. [PMID: 33726961 DOI: 10.1053/j.semdp.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/10/2021] [Accepted: 02/22/2021] [Indexed: 11/11/2022]
Abstract
The luminal gastrointestinal tract can be a site of robust immune response in which reactive lymphoproliferative processes can sometimes be difficult to distinguish from lymphoma. In this article, we review gastrointestinal tract normal resident inflammatory cells and common nonneoplastic lymphoproliferative responses with emphasis on their differential and links to lymphoma. Topics that are covered include lymphocytic esophagitis, gastric chronic inflammation, mucosa-associated lymphoid tissue, and ulceration, small intestinal lymphoid hyperplasia, celiac disease, microscopic colitis, inflammatory bowel disease, primary immunodeficiency, graft-versus-host disease, and anti-programmed cell death protein-1 effect. We additionally present the less common differential of histiocytic processes within the gastrointestinal tract. The aim of this paper is to serve as a reference for practicing pathologists facing lymphoid, lymphoplasmacytic, or histiocytic processes in the luminal gastrointestinal tract. We hope to help the practicing pathologist distinguish benign from malignant entities and identify features requiring further workup.
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Affiliation(s)
- Jennifer Y Ju
- Department of Laboratory Medicine and Pathology, University of Washington, 1959 NE Pacific St, Box 357470, Seattle, WA, United States
| | - Edward B Stelow
- Department of Pathology, University of Virginia, 1215 Lee Street, Box 800214, Charlottesville, VA, United States
| | - Elizabeth L Courville
- Department of Pathology, University of Virginia, 1215 Lee Street, Box 800214, Charlottesville, VA, United States.
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Huang S, Bai X, Fang T, Guo Y, Zheng K, Lin X. Gastrointestinal toxicities associated with immune checkpoint inhibitors: a disproportionality analysis leveraging VigiBase, the WHO Adverse Drug Reaction Database. J Zhejiang Univ Sci B 2021; 22:156-164. [PMID: 33615756 PMCID: PMC7885752 DOI: 10.1631/jzus.b2000449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
With the improvement of people's living standards, gastrointestinal adverse reactions caused by various adverse factors have attracted more and more people's attention. A recent study has indicated that coronavirus disease 2019 (COVID-19) could also invade the gastrointestinal tract, leading to gastrointestinal adverse reactions (Song et al., 2020). In recent years, immunotherapy has provided certain effects for some patients with advanced malignant tumors. A microencapsulation of immunoglobulin Y (IgY) was reported to provide an effective way to preserve IgY and improve its performance in the gastrointestinal tract (Zhang J et al., 2020). Immune checkpoint inhibitors (ICIs) can significantly improve the survival of some advanced malignant tumors, especially metastatic malignant melanoma and lung cancer (Afzal et al., 2018; Madden and Kasler, 2019). They include anti-cytotoxic T lymphocyte-associated antigen-4 (anti-CTLA-4) antibodies (ipilimumab and tremelimumab), anti-programmed cell death protein 1 (anti-PD-1) antibodies (nivolumab and pembrolizumab), and anti-programmed death-ligand 1 (anti-PD-L1) antibodies (atezolizumab, avelumab, and durvalumab) (Baxi et al., 2018). Previous studies have shown that ICI combination therapy, such as nivolumab plus ipilimumab, has particular efficacy in lung cancer, renal cell carcinoma, and malignant melanoma (Wolchok et al., 2017; Derosa et al., 2018; Doroshow et al., 2019). However, ICIs may also lead to many immune-related adverse events (irAEs), even causing severe complications in certain cases. The most well-established toxicities from ICI therapy are gastrointestinal irAEs, including enteritis, enterocolitis, microscopic colitis, and gastritis, which have attracted public attention in recent years; reports of such events associated with ICI therapy also have increased (Tandon et al., 2018; de Malet et al., 2019). These gastrointestinal irAEs may generally respond well to corticosteroids and infliximab (Haanen et al., 2017). Although most of these irAEs are low-grade, a lack of detection and timely treatment may incur severe or fatal complications.
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Affiliation(s)
- Sifu Huang
- Department of Gastroenterology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China
| | - Xuefeng Bai
- Department of Endocrinology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China
| | - Taiyong Fang
- Department of Gastroenterology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China
| | - Yanta Guo
- Department of Gastroenterology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China
| | - Kainan Zheng
- IT Application Department, Xiamen C&D Corporation Limited, Xiamen 361000, China
| | - Xiahong Lin
- Department of Endocrinology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China. .,Department of Medical Administration, the Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China.
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Arora K, Zhang ML, Goiburú-Chenu MB, England J. Pathology of immune checkpoint inhibitor-induced injury of the gastrointestinal tract and hepatobiliary system. ACTA ACUST UNITED AC 2021. [DOI: 10.1016/j.mpdhp.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Cappello G, Molea F, Campanella D, Galioto F, Russo F, Regge D. Gastrointestinal adverse events of immunotherapy. BJR Open 2021; 3:20210027. [PMID: 35707753 PMCID: PMC9185848 DOI: 10.1259/bjro.20210027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/31/2021] [Accepted: 10/04/2021] [Indexed: 11/05/2022] Open
Abstract
Cancer immunotherapy with immune-checkpoint inhibitors (ICIs) has emerged as an effective treatment for different types of cancer. ICIs are monoclonal antibodies that inhibit the signaling pathway that suppress antitumor T-cell activity. Patients benefit from increased overall and progression-free survival, but the enhancement of normal immunity can result in autoimmune manifestations, called immune-related adverse events (IRAEs), which may lead to a discontinuation of cancer therapy and to severe also life-threating events. IRAEs may affect any organs or system in the human body, being the gastrointestinal (GI) tract one of the most involved districts. Imaging plays an important role in recognizing GI IRAEs and radiologist should be familiar with the main spectrum of radiological appearance. Indeed, early detection of GI IRAEs is crucial for proper patient management and reduces morbidity and mortality. The purpose of this review is to present the most relevant imaging manifestation of GI IRAEs.
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Affiliation(s)
| | | | | | | | - Filippo Russo
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
| | - Daniele Regge
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
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El-Zimaity H, Riddell RH. Beyond Helicobacter: dealing with other variants of gastritis-an algorithmic approach. Histopathology 2020; 78:48-69. [PMID: 33382486 DOI: 10.1111/his.14283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/11/2020] [Accepted: 10/20/2020] [Indexed: 12/15/2022]
Abstract
In daily practice, the presence of inflammation in gastric biopsies prompts a mental algorithm, an early question being whether the lesion present is Helicobacter-associated. If Helicobacter organisms are not found, then there is a further algorithm, governed by the predominant type of inflammatory cells present, and the presence of other features such as intraepithelial lymphocytosis, a subepithelial collagen band, granulomas, coexisting chronic inflammation, focality, and superimposed reactive changes including erosions and ulcers. Each of these generates its own differential diagnosis. If no inflammation is present, then the two major changes specifically looked for are the changes associated with hypergastrinaemia, by far the most common cause of which is treatment with proton pump inhibitors, and reactive changes. These may be present with and without accompanying inflammation, and, when the epithelial changes dominate, the term gastropathy is preferred. In this article, we present an approach to non-Helicobacter inflammation and gastropathies.
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