当前位置: X-MOL 学术Am. J. Gastroenterol. › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Checkpoint Inhibitor-Induced Colitis.
The American Journal of Gastroenterology ( IF 8.0 ) Pub Date : 2020-02-01 , DOI: 10.14309/ajg.0000000000000497
Emanuelle Bellaguarda 1 , Stephen Hanauer
Affiliation  

Immune checkpoint inhibitors have revolutionized treatment and overall survival for several different types of cancer. Antibodies to cytotoxic T-lymphocyte-associated protein 4 and to programmed cell death protein 1 and its ligand enhance cytotoxic T-cell survival, thus augmenting antitumor action and consequently inducing immune-related adverse events, of which the most relevant is diarrhea and colitis. This review compiles recent data on pathophysiology, clinical manifestations, and treatment of immune-mediated colitis (IMC). The pathogenesis of IMC is not completely understood, but recent studies have focused on the role of regulatory T cells and interactions with the gut microbiome. While sharing similarities with inflammatory bowel disease, IMC is considered a distinct form of colitis with acute onset and rapid progression leading to potential complications including bowel perforation and death. Prompt recognition and management of IMC is imperative for optimal outcomes. Although prospective clinical trials are lacking to guide therapy, recent guidelines recommend early endoscopic evaluation to establish the diagnosis and prompt initiation of corticosteroids. Response to first-line therapy should be assessed early to determine the need of escalation to biologic agents. With treatment, most patients will experience full resolution of symptoms, and subsequent rechallenge with anti-programmed cell death protein 1 or anti-programmed death-ligand 1 inhibitors can be considered.

中文翻译:

检查点抑制剂诱发的结肠炎。

免疫检查点抑制剂彻底改变了几种不同类型癌症的治疗方法和总生存率。细胞毒性T淋巴细胞相关蛋白4和程序性细胞死亡蛋白1及其配体的抗体可增强细胞毒性T细胞存活,从而增强抗肿瘤作用并因此引发免疫相关的不良事件,其中最相关的是腹泻和结肠炎。这篇综述汇编了有关病理生理,临床表现和免疫介导的结肠炎(IMC)治疗的最新数据。IMC的发病机理尚未完全了解,但最近的研究集中在调节性T细胞的作用以及与肠道微生物组的相互作用上。虽然与炎症性肠病有相似之处,IMC被认为是结肠炎的一种独特形式,具有急性发作和快速发展,导致潜在的并发症,包括肠穿孔和死亡。及时识别和管理IMC对于获得最佳结果至关重要。尽管尚缺乏前瞻性的临床试验来指导治疗,但最近的指南建议尽早进行内窥镜评估以确立诊断并迅速开始使用糖皮质激素。应及早评估对一线疗法的反应,以确定是否需要升级为生物制剂。通过治疗,大多数患者将经历症状的完全缓解,可以考虑随后使用抗程序性细胞死亡蛋白1或抗程序性死亡配体1抑制剂进行再治疗。及时识别和管理IMC对于获得最佳结果至关重要。尽管尚缺乏前瞻性的临床试验来指导治疗,但最近的指南建议尽早进行内窥镜评估以确立诊断并迅速开始使用糖皮质激素。应及早评估对一线疗法的反应,以确定是否需要升级为生物制剂。通过治疗,大多数患者将经历症状的完全缓解,可以考虑随后使用抗程序性细胞死亡蛋白1或抗程序性死亡配体1抑制剂进行再治疗。及时识别和管理IMC对于获得最佳结果至关重要。尽管尚缺乏前瞻性的临床试验来指导治疗,但最近的指南建议尽早进行内窥镜评估以确立诊断并迅速开始使用糖皮质激素。应及早评估对一线疗法的反应,以确定是否需要升级为生物制剂。通过治疗,大多数患者将经历症状的完全缓解,可以考虑随后使用抗程序性细胞死亡蛋白1或抗程序性死亡配体1抑制剂进行再治疗。应及早评估对一线疗法的反应,以确定是否需要升级为生物制剂。通过治疗,大多数患者将经历症状的完全缓解,可以考虑随后使用抗程序性细胞死亡蛋白1或抗程序性死亡配体1抑制剂进行再治疗。应及早评估对一线疗法的反应,以确定是否需要升级为生物制剂。通过治疗,大多数患者将经历症状的完全缓解,可以考虑随后使用抗程序性细胞死亡蛋白1或抗程序性死亡配体1抑制剂进行再治疗。
更新日期:2020-02-07
down
wechat
bug