Checkpoint Inhibitor-Induced Colitis: An Update DOI Creative Commons
Giuseppe Losurdo,

Daniele Angelillo,

Nicolas Favia

et al.

Biomedicines, Journal Year: 2023, Volume and Issue: 11(5), P. 1496 - 1496

Published: May 22, 2023

Immunotherapy with immune checkpoint inhibitors (ICIs) nowadays has indications for several solid tumors. The current targets ICIs are CTLA-4, PD-1, and PD-L1 receptors. Despite the clinical advantages derived from ICIs, a variety of side effects linked to overstimulation system. Among these, ICI-related colitis is one most common, disabling impact on patient. Diarrhea, abdominal pain, distension, cramping, hematochezia common ICI enterocolitis presenting symptoms. frequently used grading system assessment severity called Common Terminology Criteria Adverse Events (CTCAE) grading. With regard histological picture, there no specific feature; however, microscopic damage can be classified into five types: (1) acute active colitis, (2) chronic (3) colitis-like, (4) graft-versus-host disease-like, (5) other types. Supportive therapy (oral hydration, bland diet without lactose or caffeine, anti-diarrheal agents) indicated in mild colitis. Symptomatic treatment alone loperamide, low-fiber diet, spasmolytics recommended low-grade diarrhea. In more severe cases, corticosteroid mandatory. refractory off-label use biological therapies (infliximab vedolizumab) was proposed.

Language: Английский

Understanding and treating the inflammatory adverse events of cancer immunotherapy DOI Creative Commons
Michael Dougan, Adrienne Luoma, Stephanie K. Dougan

et al.

Cell, Journal Year: 2021, Volume and Issue: 184(6), P. 1575 - 1588

Published: March 1, 2021

Language: Английский

Citations

212
Risk Factors and Biomarkers for Immune-Related Adverse Events: A Practical Guide to Identifying High-Risk Patients and Rechallenging Immune Checkpoint Inhibitors DOI Creative Commons
Adithya Chennamadhavuni, Laith Abushahin, Ning Jin

et al.

Frontiers in Immunology, Journal Year: 2022, Volume and Issue: 13

Published: April 26, 2022

Immune-related adverse events (irAEs) are a range of complications associated with the use immune-checkpoint inhibitors (ICIs). Two major classes ICIs widely used Cytotoxic T-Lymphocyte Antigen 4 (CTLA4) and Programmed Cell death-1 (PD-1)/Programmed death-ligand 1 (PD-L1) inhibitors. High-grade irAEs life-threatening often cause severe decline in performance status such that patients do not qualify for any further anticancer treatments. It is difficult to generalize evidence current literature on risk factors or biomarkers entire class as studies so far either disease-specific (e.g., lung cancer melanoma) ICI agent-specific pembrolizumab, ipilimumab) irAE-specific pneumonitis gastritis). In this review, consider before initiating monitoring listed practical purpose day-to-day practice. Risk grouped into demographics social history, medical medication tumor-specific factors. A higher irAE age <60 years, high body mass index, women CTLA4 men PD-1/PD-L1 agents, chronic smokers. Patients significant kidney (Stage IV-V), cardiac (heart failure, coronary artery disease, myocardial infarction, hypertension), (asthma, pulmonary fibrosis, obstructive disease) at respective organ-specific irAEs. Pre-existing autoimmune disease certain drugs (proton pump inhibitors, diuretics, anti-inflammatory drugs) also increase irAE-risk. Biomarkers categorized circulating blood counts, cytokines, autoantibodies, HLA genotypes, microRNA, gene expression profiling, serum proteins. The counts protein markers (albumin thyroid-stimulating hormone) readily accessible High neutrophil-lymphocyte ratio, eosinophil/monocyte/lymphocyte counts; TSH troponins diagnosis drop white count lymphocyte can predict irAE. Other limited profiling. With fast-expanding approvals various types, knowledge help providers assess irAE-risk their patients. Prospective needed provide insight essential aspect therapy.

Language: Английский

Citations

212
Drug-induced liver injury: a comprehensive review DOI Creative Commons
Tom Hosack,

Djamil Damry,

Sujata Biswas

et al.

Therapeutic Advances in Gastroenterology, Journal Year: 2023, Volume and Issue: 16

Published: Jan. 1, 2023

Drug-induced liver injury (DILI) remains a challenge in clinical practice and is still diagnosis of exclusion. Although it has low incidence amongst the general population, DILI accounts for most cases acute failure with fatality rate up to 50%. While multiple mechanisms have been postulated, there no clear causal relationship between drugs, risk factors DILI. Current best relies on combination high suspicion, thorough history timeline, extensive hepatological investigations as supported by international Roussel Uclaf Causality Assessment Method criteria, latter considered key diagnostic algorithm This review focuses classification, factors, evaluation, future biomarkers management, aim facilitating physicians correctly identify early presentation.

Language: Английский

Citations

88
Tumor inflammation-associated neurotoxicity DOI
Jasia Mahdi, Jörg Dietrich, Karin Straathof

et al.

Nature Medicine, Journal Year: 2023, Volume and Issue: 29(4), P. 803 - 810

Published: April 1, 2023

Language: Английский

Citations

68
Clinical pattern of checkpoint inhibitor-induced liver injury in a multicentre cohort DOI Creative Commons
Lina Hountondji, Christophe Ferreira De Matos, Fanny Lebossé

et al.

JHEP Reports, Journal Year: 2023, Volume and Issue: 5(6), P. 100719 - 100719

Published: March 7, 2023

Language: Английский

Citations

52
Steroid-refractory immune mediated hepatitis managed with budesonide in patients with metastatic melanoma: proof of concept and literature review DOI Creative Commons
Roma Kankaria, Douglas B. Johnson

The Oncologist, Journal Year: 2025, Volume and Issue: 30(1)

Published: Jan. 1, 2025

Abstract Immune checkpoint inhibitors (ICIs) have advanced the treatment of metastatic melanoma. However, some patients develop ICI-associated toxicities like hepatitis (ie, immune-mediated hepatitis; IMH). Although these usually resolve with steroids, steroid-refractory events may occur, which be a major source morbidity and mortality without obviously defined algorithms. Herein, we present 2 melanoma who had IMH that was only partially mycophenolate-responsive, but fully resolved budesonide. The case suggests budesonide is potential option to treat refractory standard treatments, further investigation in larger series needed identify most optimal setting for use.

Language: Английский

Citations

2
Immune‐Mediated Liver Injury From Checkpoint Inhibitor: An Evolving Frontier With Emerging Challenges DOI Creative Commons
Lily Dara,

Eleonora De Martin

Liver International, Journal Year: 2025, Volume and Issue: 45(2)

Published: Jan. 27, 2025

ABSTRACT Over the past decade, immune checkpoint inhibitors (ICIs) have transformed treatment of cancer, though they come with risk immune‐related adverse (irAEs) events such as hepatotoxicity or Immune‐mediated Liver Injury from Checkpoint Inhibitors (ILICI). ILICI is a serious irAE that, when severe, requires cessation ICI and initiation immunosuppression. Cytotoxic T Lymphocytes (CTLs) play central role in ILICI; however, are just part picture immunotherapy broadly impacts all aspects microenvironment can directly indirectly activate innate adaptive cells. Clinically, our understanding this entity grows, we encounter new challenges. The presentation heterogeneous respect to latency, pattern injury (hepatitis vs. cholangitis) severity. This review focuses on knowledge regarding factors, including refractory steroids. An emerging topic, possibility rechallenge while accepting some risk, patients who experience but require immunotherapy, also discussed. provides an update current knowns unknowns highlights several gaps where studies needed.

Language: Английский

Citations

2
Immune Checkpoint Inhibitor-Associated Colitis: From Mechanism to Management DOI Creative Commons

Liansha Tang,

Jialing Wang, Nan Lin

et al.

Frontiers in Immunology, Journal Year: 2021, Volume and Issue: 12

Published: Dec. 21, 2021

Immune checkpoint inhibitors (ICIs), as one of the innovative types immunotherapies, including programmed cell death-1 (PD-1), death-ligand 1 (PD-L1), and cytotoxic T lymphocyte antigen 4 (CTLA-4) inhibitors, have obtained unprecedented benefit in multiple malignancies. However, immune response activation body organs could arise immune-related adverse events (irAEs). Checkpoint inhibitor colitis (CIC) is most widely reported irAEs. some obscure problems, such mechanism concerning gut microbiota, confusing differential diagnosis with inflammatory bowel disease (IBD), optimal steroid schedule, reintroduction ICIs, controversial prognosis features, influence deep understanding precise management CIC. Herein, we based on these problems comprehensively summarized relevant studies CIC patients NSCLC, further discussing future research direction this specific pattern

Language: Английский

Citations

93
Oncologic emergencies and urgencies: A comprehensive review DOI Open Access
Bonnie E. Gould Rothberg, Tammie E. Quest, Sai‐Ching J. Yeung

et al.

CA A Cancer Journal for Clinicians, Journal Year: 2022, Volume and Issue: 72(6), P. 570 - 593

Published: June 2, 2022

Abstract Patients with advanced cancer generate 4 million visits annually to emergency departments (EDs) and other dedicated, high‐acuity oncology urgent care centers. Because of both the increasing complexity systemic treatments overall higher rates active therapy in geriatric population, many patients experiencing acute decompensations are frail acutely ill. This article comprehensively reviews spectrum oncologic emergencies urgencies typically encountered settings. Presentation, underlying etiology, up‐to‐date clinical pathways discussed. Criteria for either a safe discharge home or transition inpatient hospitalist team emphasized. review extends beyond familiar conditions such as febrile neutropenia, hypercalcemia, tumor lysis syndrome, malignant spinal cord compression, mechanical bowel obstruction, breakthrough pain crises include broader topics encompassing syndrome inappropriate antidiuretic hormone secretion, venous thromboembolism effusions, well chemotherapy‐induced mucositis, cardiomyopathy, nausea, vomiting, diarrhea. Emergent complications associated targeted therapeutics, including small molecules, naked drug‐conjugated monoclonal antibodies, immune checkpoint inhibitors chimeric antigen receptor T‐cells, summarized. Finally, strategies facilitating same‐day direct admission hospice from ED not only can serve point‐of‐care reference physician but also assist outpatient oncologists hospitalists coordinating around visit.

Language: Английский

Citations

64
Cancer in Inflammatory Bowel Disease DOI
Adam S. Faye, Ariela K. Holmer, Jordan E. Axelrad

et al.

Gastroenterology Clinics of North America, Journal Year: 2022, Volume and Issue: 51(3), P. 649 - 666

Published: Aug. 30, 2022

Language: Английский

Citations

52