Weingarden AR, Rubin SJS, Gubatan J. Immune checkpoint inhibitor-mediated colitis in gastrointestinal malignancies and inflammatory bowel disease. World J Gastrointest Oncol 2021; 13(8): 772-798 [PMID: 34457186 DOI: 10.4251/wjgo.v13.i8.772]
Corresponding Author of This Article
Alexa R Weingarden, MD, PhD, Academic Fellow, Consultant Physician-Scientist, Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, 420 Broadway Street, Pavilion D, 2nd Floor, Redwood City, CA 94063, United States. aweingar@stanford.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
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/
World J Gastrointest Oncol. Aug 15, 2021; 13(8): 772-798 Published online Aug 15, 2021. doi: 10.4251/wjgo.v13.i8.772
Immune checkpoint inhibitor-mediated colitis in gastrointestinal malignancies and inflammatory bowel disease
Alexa R Weingarden, Samuel J S Rubin, John Gubatan
Alexa R Weingarden, John Gubatan, Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Redwood City, CA 94063, United States
Samuel J S Rubin, Stanford University School of Medicine, Stanford University, Redwood City, CA 94063, United States
Author contributions: Weingarden AR and Gubatan J planned and designed the study; Weingarden AR and SJR performed the literature review; Rubin SJS and Gubatan J provided critical review of the manuscript; Weingarden AR and Rubin SJS drafted the manuscript; all authors interpreted the results and contributed to critical review of the manuscript; Weingarden AR had full access to the study data and takes responsibility for the integrity of the data and accuracy of the analysis.
Conflict-of-interest statement: Authors have no conflicts of interests or financial disclosures relevant to this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: Alexa R Weingarden, MD, PhD, Academic Fellow, Consultant Physician-Scientist, Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, 420 Broadway Street, Pavilion D, 2nd Floor, Redwood City, CA 94063, United States. aweingar@stanford.edu
Received: February 8, 2021 Peer-review started: February 8, 2021 First decision: March 29, 2021 Revised: April 9, 2021 Accepted: July 9, 2021 Article in press: July 9, 2021 Published online: August 15, 2021
Abstract
Immune checkpoint inhibitors (ICI) have markedly changed the landscape of cancer therapy. By re-invigorating the immune system against tumors, ICI provide novel therapeutic options for a broad variety of malignancies, including many gastrointestinal (GI) cancers. However, these therapies can also induce autoimmune-like side effects in healthy tissue across the body. One of the most common of these side effects is ICI-mediated colitis and diarrhea (IMC). Here, we review the incidence and risk of IMC in ICI therapy, with a focus on what is known regarding IMC in patients with GI malignancies. We also discuss data available on the use of ICI and risk of IMC in patients with pre-existing inflammatory bowel disease, as these patients may have increased risk of IMC due to their underlying intestinal pathology.
Core Tip: Immune checkpoint inhibitor-mediated colitis and diarrhea (IMC) is a common immune-related adverse event with immune checkpoint inhibitor (ICI) therapy. The risk of IMC is most strongly associated with type of ICI used, but race, malignancy, and vitamin D use may also contribute to the risk of developing IMC. IMC incidence in gastrointestinal cancers appears comparable to other malignancies, but this is hampered by lack of a consistent definition for IMC and confounding by contemporaneous chemotherapy. Although patients with inflammatory bowel disease (IBD) are often excluded from treatment with ICI, available data suggest that they have increased risk of diarrhea and/or colitis compared to patients without IBD.
