Immunotherapy related colitis

Abstract

INTRODUCTION: Immune checkpoint inhibitors (ICIs) are one of the most innovative ways to treat cancer. Important molecular targets are cytotoxic T-cell antigen-4, programmed cell death protein receptor (PD-1) and ligand (PD-L1). The specific antibodies against immune checkpoints work by resetting the immune system to turn against cancer cells. Immunotherapy, probably due to the overactivation of the immune system, causes a series of side effects with colitis being one of the most common. Its severity depends on the type of treatment and the dose administered. Higher doses of ipilimumab (CTLA-4) are associated with an increased risk of developing grade 3 and 4 colitis. AIM: To highlight the incidence, the degree of intensity of colitis due to immunotherapy and its impact on the treatment of patients. MATERIAL AND METHOD: A systematic literature review was carried out, utilizing the PubMed and Science Direct databases. 18 primary clinical studies meeting the criteria of this systematic review were included. RESULTS: The administration of ICIs is a treatment option for lung, kidney, urothelial and melanoma cancer. Immunotherapy-induced colitis is the most common side effect, with incidence rates ranging from 2.8% to 50%. Cases of discontinuation, suspension or change of treatment are reported in patients with a high degree of toxicity and deaths when toxicity is grade 4 - 5. CONCLUSIONS: ICIs are widely used for the treatment of many types of malignancies. Although the benefit to patient survival is significant, the occurrence of side effects and in particular colitis may make it difficult to continue treatment, with possible permanent discontinuation, and possibility for death. Early recognition of colitis and its proper management, applying modern guidelines, is essential.