British Society of Gastroenterology endorsed guidance for the management of immune checkpoint inhibitor-induced enterocolitis

Nick Powell; Hajir Ibraheim; Tim Raine; Richard A Speight; Sophie Papa; Oliver Brain; Michael Green; Mark A Samaan; Lavinia Spain; Nadia Yousaf; Nikki Hunter; Lucy Eldridge; Polychronis Pavlidis; Peter Irving; Bu'Hussain Hayee; Samra Turajlic; James Larkin; James O Lindsay; Martin Gore

doi:10.1016/S2468-1253(20)30014-5

British Society of Gastroenterology endorsed guidance for the management of immune checkpoint inhibitor-induced enterocolitis

Lancet Gastroenterol Hepatol. 2020 Jul;5(7):679-697. doi: 10.1016/S2468-1253(20)30014-5.

Authors

Nick Powell¹, Hajir Ibraheim², Tim Raine³, Richard A Speight⁴, Sophie Papa⁵, Oliver Brain⁶, Michael Green⁷, Mark A Samaan⁸, Lavinia Spain⁹, Nadia Yousaf⁹, Nikki Hunter⁹, Lucy Eldridge⁹, Polychronis Pavlidis¹⁰, Peter Irving⁸, Bu'Hussain Hayee¹¹, Samra Turajlic¹², James Larkin⁹, James O Lindsay¹³, Martin Gore⁹

Affiliations

¹ Division of Digestive Diseases, Faculty of Medicine, Imperial College London, UK; The Royal Marsden Hospital, London, UK. Electronic address: [email protected].
² Division of Digestive Diseases, Faculty of Medicine, Imperial College London, UK; The Royal Marsden Hospital, London, UK.
³ Addenbrooke's Hospital, Cambridge University Teaching Hospitals NHS Foundation Trust, Cambridge, UK.
⁴ Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK; Institute of Cellular Medicine, Newcastle University, Newcastle, UK.
⁵ School of Cancer and Pharmaceutical Sciences, King's College London, London, UK; Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁶ Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
⁷ Department of Histopathology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁸ Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁹ The Royal Marsden Hospital, London, UK.
¹⁰ Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK; Centre for Inflammation and Cancer Immunology, King's College London, London, UK.
¹¹ Department of Gastroenterology, King's College Hospital, London, UK.
¹² The Royal Marsden Hospital, London, UK; Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK.
¹³ The Royal London Hospital, Barts Health NHS Trust, London, UK; Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.

PMID: 32553146
DOI: 10.1016/S2468-1253(20)30014-5

Abstract

Immune checkpoint inhibitors are a novel class of cancer treatment that have improved outcomes for a subset of cancer patients. They work by antagonising inhibitory immune pathways, thereby augmenting immune-mediated antitumour responses. However, immune activation is not cancer-specific and often results in the activation of immune cells in non-cancer tissues, resulting in off-target immune-mediated injury and organ dysfunction. Diarrhoea and gastrointestinal tract inflammation are common and sometimes serious side-effects of this type of therapy. Prompt recognition of gastrointestinal toxicity and, in many cases, rapid institution of anti-inflammatory or biologic therapy (or both) is required to reverse these complications. Management of organ-specific complications benefits from multidisciplinary input, including engagement with gastroenterologists for optimal management of immune checkpoint inhibitor-induced enterocolitis. In this British Society of Gastroenterology endorsed guidance document, we have developed a consensus framework for the investigation and management of immune checkpoint inhibitor-induced enterocolitis.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Adrenal Cortex Hormones / therapeutic use
Antibodies, Monoclonal, Humanized / adverse effects*
Antibodies, Monoclonal, Humanized / therapeutic use
Antibodies, Monoclonal, Humanized / toxicity
Antineoplastic Agents, Immunological / adverse effects*
Antineoplastic Agents, Immunological / therapeutic use
Antineoplastic Agents, Immunological / toxicity
Consensus
Endoscopy / methods
Endoscopy, Digestive System / methods
Enterocolitis / chemically induced*
Enterocolitis / drug therapy
Enterocolitis / metabolism
Gastroenterology / organization & administration
Gastrointestinal Diseases / chemically induced
Gastrointestinal Diseases / diagnostic imaging
Gastrointestinal Diseases / pathology
Guidelines as Topic
Humans
Infliximab / therapeutic use
Lactoferrin / metabolism
Leukocyte L1 Antigen Complex / metabolism
Neoplasms / drug therapy*
Patient Care Management / methods
Societies, Medical / organization & administration*
Tumor Necrosis Factor-alpha / antagonists & inhibitors
United Kingdom / epidemiology

Substances

Adrenal Cortex Hormones
Antibodies, Monoclonal, Humanized
Antineoplastic Agents, Immunological
Leukocyte L1 Antigen Complex
Tumor Necrosis Factor-alpha
vedolizumab
Infliximab
Lactoferrin

Abstract

Publication types

MeSH terms

Substances

Grants and funding