Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed

Checkpoint Inhibitors Induced Colitis: From Pathogenesis to Management

Maria Terrin
,
Giulia Migliorisi
,
Arianna Dal Buono
ORCID logo ,
Roberto Gabbiadini
,
Elisabetta Mastrorocco
,
Alessandro Quadarella
,
Alessandro Repici
,
Armando Santoro
,
Alessandro Armuzzi
* ORCID logo
Version 1 : Received: 23 May 2023 / Approved: 25 May 2023 / Online: 25 May 2023 (08:03:37 CEST)

A peer-reviewed article of this Preprint also exists.

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. 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.

Abstract

The advent of immunotherapy and 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 develop immune-related adverse events, being the gastrointestinal tract often affected with different grades of mucosal inflammation. Checkpoint inhibitors colitis (CIC) presents with watery or bloody diarrhoea and in case of severe activity requires ICIs discontinuation. The pathogenesis of CIC is multifactorial and still partially unknow: 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 open issues remain on treatment timing and options, and biological treatment, above all with anti-TNF alpha, can be offered to these patients aiming to rapidly resume the oncological therapies. This review aims to summarize the pathogenetic mechanisms underlying CIC and to discuss evidenced-based management including the role of biological therapy.

Keywords

checkpoint inhibitors; colitis; immune-related adverse events; enterocolitis; diarrhea

Subject

Medicine and Pharmacology, Gastroenterology and Hepatology

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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