British Society of Gastroenterology endorsed guidance for the management of immune checkpoint inhibitor-induced enterocolitis.
Powell N., Ibraheim H., Raine T., Speight RA., Papa S., Brain O., Green M., Samaan MA., Spain L., Yousaf N., Hunter N., Eldridge L., Pavlidis P., Irving P., Hayee B., Turajlic S., Larkin J., Lindsay JO., Gore M.
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.