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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
New strategies in the diagnosis and treatment of immune-checkpoint inhibitor-mediated colitis
Tsvetelina Velikova, Boris Krastev, Milena Gulinac, Miroslav Zashev, Vasko Graklanov, Milena Peruhova
Tsvetelina Velikova, Milena Gulinac, Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
Boris Krastev, Medical Center Nadezhda, Medical Center Nadezhda, Sofia 1407, Bulgaria
Milena Gulinac, General and Clinical Pathology, Medical University of Plovdiv, Plovdiv 4002, Bulgaria
Miroslav Zashev, Department of General Surgery, University Hospital “Heart and Brain”, Burgas 8000, Bulgaria
Vasko Graklanov, First Department of Internal Diseases, Medical University of Plovdiv, Plovdiv 4000, Bulgaria
Vasko Graklanov, Department of Hematology, University Hospital “St. George”, Plovdiv 4000, Bulgaria
Milena Peruhova, Division of Gastroenterology, University Hospital “Heart and Brain”, Burgas 1000, Bulgaria
Author contributions: Peruhova M and Velikova T contributed to conceptualization; Krastev B and Gulinac M contributed to methodology; Zashe M contributed to software; Peruhova M and Graklanov V contributed to resources; Zashev M and Graklanov V contributed to data curation; Velikova T, Gulinac M, and Peruhova M contributed to visualization; Peruhova M, Krastev B, Gulinac M, and Zashev M wrote the original draft; Velikova T contributed to review and editing the manuscript, English language proofreading, funding acquisition, and supervision; all authors revised and approved the final version of the manuscript prior to submission.
Supported by the European Union-NextGenerationEU, through the National Recovery and Resilience Plan of the Republic of Bulgaria, No. BG-RRP-2.004-0008.
Conflict-of-interest statement: The authors declare having no conflicts of interest.
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 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:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Milena Peruhova, MD, Assistant Professor, Chief Physician, Division of Gastroenterology, University Hospital “Heart and Brain”, 1 Zdrave Street, Burgas 1000, Bulgaria. mperuhova@gmail.com
Received: October 27, 2023
Peer-review started: October 27, 2023
First decision: December 6, 2023
Revised: December 20, 2023
Accepted: January 19, 2024
Article in press: January 19, 2024
Published online: February 26, 2024
Immune-checkpoint inhibitor-mediated colitis (IMC) is an increasingly recognized adverse event in cancer immunotherapy, particularly associated with immune checkpoint inhibitors (ICIs) such as anti-cytotoxic T-lymphocyte antigen-4 and anti-programmed cell death protein-1 antibodies. As this revolutionary immunotherapy gains prominence in cancer treatment, understanding, diagnosing, and effectively managing IMC becomes paramount. IMC represents a unique challenge due to its immune-mediated nature and potential for severe complications. However, a precise picture of IMC pathophysiology is currently unavailable. Therefore, we aimed to summarize the existing data while acknowledging the need for further research. This comprehensive review explores the mechanisms underlying ICIs, gastrointestinal adverse effects, and, in particular, IMC’s incidence, prevalence, and features. Our review also emphasizes the importance of recognizing IMC’s distinct clinical and histopathological features to differentiate it from other forms of colitis. Furthermore, this paper highlights the urgent need for evolving diagnostic methods, therapeutic strategies, and a multidisciplinary approach to effectively manage IMC.
Core Tip: Diagnosing and managing immune-checkpoint inhibitor-mediated colitis (IMC) is essential for optimizing the benefits of cancer immunotherapy. This review underscores the importance of accurate diagnosis, differentiating IMC from other forms of colitis, and tailoring treatment strategies for optimal outcomes. Multidisciplinary approaches, including endoscopy, histopathology, and immune profiling, are crucial in diagnosing IMC. Treatment options range from corticosteroids to immunosuppressants, and a personalized approach is often required. Collaborative efforts between oncologists, gastroenterologists, and pathologists are critical to effectively manage this emerging immune-related adverse event.
