Minireviews
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Dec 16, 2018; 10(12): 392-399
Published online Dec 16, 2018. doi: 10.4253/wjge.v10.i12.392
Endoscopic evaluation of immunotherapy-induced gastrointestinal toxicity
Isabel Iranzo, Jose María Huguet, Patricia Suárez, Luis Ferrer-Barceló, Vega Iranzo, Javier Sempere
Isabel Iranzo, Jose María Huguet, Patricia Suárez, Luis Ferrer-Barceló, Javier Sempere, Digestive Disease Department, General University Hospital of Valencia, Valencia 46014, Spain
Vega Iranzo, Oncology Department, General University Hospital of Valencia, Valencia 46014, Spain
Author contributions: Iranzo I, Huguet JM, Suárez P, Ferrer-Barceló L, Iranzo V and Sempere J conceived the study and drafted the manuscript; all of the authors contributed to and approved the final version of the manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author to: Jose María Huguet, PhD, Assistant Professor, Digestive Disease Department, General University Hospital of Valencia, Avenida Tres Cruces, 2, Valencia 46014, Spain. huguet_jos@gva.es
Telephone: +34-60-6394982 Fax: +34-96-3131901
Received: August 27, 2018
Peer-review started: August 27, 2018
First decision: October 5, 2018
Revised: November 20, 2018
Accepted: December 10, 2018
Article in press: December 11, 2018
Published online: December 16, 2018
Processing time: 117 Days and 12.1 Hours
Abstract

Immunotherapy is any treatment aimed at boosting or enhancing the immune system. It includes a wide range of options, from vaccines to treatment for conditions such as allergy and cancer. In the case of cancer, unlike other available treatments, immunotherapy is not aimed at destroying the tumor cells but at stimulating the patient’s immune system so that it attacks the tumor. In cancer, immunotherapy provides a series of advantages. Nevertheless, immunotherapy administered for treatment of cancer is associated with immune-mediated enterocolitis. Colitis mediated by monoclonal anti-cytotoxic T lymphocyte–associated antigen 4 and to programmed cell death protein 1 and its ligand PDL1 shares characteristics with chronic inflammatory bowel disease (IBD), and similar findings have been reported for both the endoscopy images and the segment involved. The most frequent lesions on endoscopy are ulcer and erythema, and the most frequently affected site is the sigmoid colon. A segmental pattern has been reported to be slightly more frequent than a continuous pattern. In addition, upper gastrointestinal lesions have been reported in up to half of patients, with the most frequent findings being gastritis and erosive duodenitis. As is the case in IBD, systemic corticosteroids and immunosuppressive treatment (anti-TNF agents) are the approaches used in patients with a more unfavorable progression. Immunotherapy must be suspended completely in some cases.

Keywords: Enterocolitis; Ipilimumab; Immunotherapy; Immune-related adverse event; Nivolumab; Toxicity; Endoscopy

Core tip: Widespread use of immunotherapy in various types of cancer has led to reports of new associated adverse effects resulting from increased stimulation of the immune system, which can confuse the body’s own tissues and organs with foreign matter, thus leading it to attack the body’s healthy tissue. The most frequent immune-mediated adverse effects include asthenia, general malaise, fever, gastrointestinal toxicity (abdominal pain, diarrhea, and colitis), cutaneous toxicity, hypothyroidism and hepatitis. This review of the endoscopic evaluation of immunotherapy-induced toxicity presents the most typical endoscopic images, the differential diagnosis based on these images, and the initial management.