Monoclonal Antibodies for Checkpoint Inhibitors and Sprue-Like Intestinal Disease
Hugh J Freeman*
Department of Medicine (Gastroenterology), University of British Columbia, Vancouver, BC, Canada
*Corresponding Author: Hugh J Freeman, Department of Medicine (Gastroenterology), University of British Columbia, Vancouver, BC, Canada.
May 31, 2023; Published: June 12, 2023
Biologically active monoclonal antibodies functioning as checkpoint inhibitors have been used in cancer treatment with improved overall patient survival. Infusions may be complicated by development of diarrhea, sometimes severe. In some, an immune-mediated enterocolitis occurs, sometimes difficult to treat, occasionally with a fatal outcome. Less well appreciated are other less commonly detected forms of colitis, such as collagenous colitis, as well as alterations in the small bowel alone, including a distinctive sprue-like intestinal disease. These may all be entirely independent inflammatory processes. Together, these likely represent different phenotypic expressions of treatment toxicity in the intestinal tract following management of cancer with infused checkpoint inhibitor monoclonal antibodies.
Celiac Disease; Sprue-like Intestinal Disease; Enteritis; Enterocolitis; Checkpoint Inhibitors; Advanced Malignancy; Metastatic Melanoma
- Romano E., et al. “Ipilimumab-dependent cell-mediated cytotoxicity of regulatory T cells ex vivo by nonclassical monocytes in melanoma patients”. Proceedings of the National Academy of Sciences of the United States of America 112 (2015): 6140-6145.
- Topalian SL., et al. “Safety, activity, and immune correlates of anti-PD-1 antibody in cancer”. The New England Journal of Medicine 366 (2012): 5443-5454.
- Ribas A., et al. “Association of pembrolizumab with tumor response and survival among patients with advanced melanoma”. JAMA 315 (2016): 1600-1609.
- Borghaei H., et al. “Nivolimumab versus docetaxel in advanced nonsquamous non-small-cell lung cancer”. The New England Journal of Medicine 373 (2015): 1627-1639.
- Postow MA., et al. “Immune checkpoint blockade in cancer therapy”. Journal of Clinical Oncology 33 (2015): 1974-1982.
- Shah R., et al. “Ipilimumab as a cause of severe pan-colitis and colonic perforation”. Cureus 9 (2017): e1182.
- Bellaguarda E and Hanauer S. “Checkpoint inhibitor-induced colitis”. American Journal of Gastroenterology 115 (2020): 202-210.
- Ascierto PA., et al. “Ipilimumab 10mg/kg versus ipilimumab 3 mg/kg in patients with unresectable or metastatic melanoma: a randomized, double-blind, multicenter, phase 3 trial”. Lancet Oncology 18 (2017): 611-622.
- Barnes MJ., et al. “CTLA-4 promotes Foxp induction and regulatory T-cell accumulation in the intestinal lamina propria”. Mucosal Immunology 6 (2013): 324-334.
- Marthey L., et al. “Cancer immunotherapy with anti CTLA-4 monoclonal antibododies induces an inflammatory bowel disease”. Journal of Crohn's and Colitis 10 (2016): 395-401.
- Coutzac C., et al. “Colon immune-related adverse events: anti-CTLA-4 and anti-PD-1 blockade induced distinct immunopathological entities”. Journal of Crohn's and Colitis 11 (2017): 1238-1246.
- Rajha E., et al. “Gastrointestinal adverse events associated with immune checkpoint inhibitor therapy”. Gastroenterology Report (Oxf) 8 (2019): 25-30.
- Sanders D., et al. “Enteritis with immune checkpoint inhibitor use”. CMAJ 191 (2019): E1106.
- Baroudjian B., et al. “Anti-PD1-induced collagenous colitis in a melanoma patient”. Melanoma Research 26 (2016): 30-311.
- Freeman HJ. “Role of biopsy in diagnosis and treatment of adult celiac disease”. Gastroenterology and Hepatology from Bed to Bench 11 (2018): 191-196.
- Freeman HJ. “Mucosal recovery and mucosal healing in biopsy-defined adult celiac disease”. International Journal of Celiac Disease 5 (2017): 14-18.
- Freeman HJ. “Refractory celiac disease and sprue-like intestinal disease”. World Journal of Gastroenterology 14 (2008): 828-830.
- Freeman HJ. “Olmesartan enteropathy”. International Journal of Celiac Disease 4 (2016): 24-26.
- Gentile M., et al. “Association between Ipilimumab and celiac disease”. Mayo Clinic Proceedings 88 (2013): 414-417.
- Duval L., et al. “Nivolumab-induced celiac-like enteropathy in patient with metastatic renal cell carcinoma: case report and review of the literature”. Clinical Case Reports 7 (2019): 1689-1693.
- Facchinetti F., et al. “Widespread nivolumab-induced enteropathy in a long responder non-small-cell lung cancer patient”. Clinical Lung Cancer 19 (2018): e591-e596.
- Arnouk J., et al. “A celiac disease phenotype after checkpoint inhibitor exposure: an example of immune dysregulation after immunotherapy”. ACG Case Reports Journal 6 (2019): e00158.
- Alsaadi D., et al. “A case of checkpoint inhibitor-induced celiac disease”. Journal of Immunotherapy Cancer 7 (2019): 203.