Characteristics of Immune Checkpoint Inhibitor-Associated Gastritis: Report from a Major Tertiary Care Center.
Humans
Immune Checkpoint Inhibitors
/ therapeutic use
Retrospective Studies
Carcinoma, Non-Small-Cell Lung
/ drug therapy
Melena
/ complications
Tertiary Care Centers
Lung Neoplasms
/ drug therapy
Gastritis
/ chemically induced
Helicobacter Infections
Abdominal Pain
/ complications
Vomiting
/ drug therapy
Nausea
/ drug therapy
Journal
The oncologist
ISSN: 1549-490X
Titre abrégé: Oncologist
Pays: England
ID NLM: 9607837
Informations de publication
Date de publication:
03 08 2023
03 08 2023
Historique:
received:
08
11
2022
accepted:
20
01
2023
medline:
7
8
2023
pubmed:
12
3
2023
entrez:
11
3
2023
Statut:
ppublish
Résumé
Immune checkpoint inhibitors (ICIs) have increased our ability to treat an ever-expanding number of cancers. We describe a case series of 25 patients who were diagnosed with gastritis following ICI therapy. This was a retrospective study involving 1712 patients treated for malignancy with immunotherapy at Cleveland Clinic from January 2011 to June 2019 (IRB 18-1225). We searched electronic medical records using ICD-10 codes for gastritis diagnosis confirmed on endoscopy and histology within 3 months of ICI therapy. Patients with upper gastrointestinal tract malignancy or documented Helicobacter pylori-associated gastritis were excluded. Twenty-five patients were found to meet the criteria for diagnosis of gastritis. Of these 25 patients, most common malignancies were non-small cell lung cancer (52%) and melanoma (24%). Median number of infusions preceding symptoms was 4 (1-30) and time to symptom onset 2 (0.5-12) weeks after last infusion. Symptoms experienced were nausea (80%), vomiting (52%), abdominal pain (72%), and melena (44%). Common endoscopic findings were erythema (88%), edema (52%), and friability (48%). The most common diagnosis of pathology was chronic active gastritis in 24% of patients. Ninety-six percent received acid suppression treatment and 36% of patients also received steroids with an initial median dose of prednisone 75 (20-80) mg. Within 2 months, 64% had documented complete resolution of symptoms and 52% were able to resume immunotherapy. Patients presenting with nausea, vomiting, abdominal pain, or melena following immunotherapy should be assessed for gastritis and if other causes are excluded, may require treatment as consideration for complication of immunotherapy.
Sections du résumé
BACKGROUND
Immune checkpoint inhibitors (ICIs) have increased our ability to treat an ever-expanding number of cancers. We describe a case series of 25 patients who were diagnosed with gastritis following ICI therapy.
MATERIALS AND METHODS
This was a retrospective study involving 1712 patients treated for malignancy with immunotherapy at Cleveland Clinic from January 2011 to June 2019 (IRB 18-1225). We searched electronic medical records using ICD-10 codes for gastritis diagnosis confirmed on endoscopy and histology within 3 months of ICI therapy. Patients with upper gastrointestinal tract malignancy or documented Helicobacter pylori-associated gastritis were excluded.
RESULTS
Twenty-five patients were found to meet the criteria for diagnosis of gastritis. Of these 25 patients, most common malignancies were non-small cell lung cancer (52%) and melanoma (24%). Median number of infusions preceding symptoms was 4 (1-30) and time to symptom onset 2 (0.5-12) weeks after last infusion. Symptoms experienced were nausea (80%), vomiting (52%), abdominal pain (72%), and melena (44%). Common endoscopic findings were erythema (88%), edema (52%), and friability (48%). The most common diagnosis of pathology was chronic active gastritis in 24% of patients. Ninety-six percent received acid suppression treatment and 36% of patients also received steroids with an initial median dose of prednisone 75 (20-80) mg. Within 2 months, 64% had documented complete resolution of symptoms and 52% were able to resume immunotherapy.
CONCLUSION
Patients presenting with nausea, vomiting, abdominal pain, or melena following immunotherapy should be assessed for gastritis and if other causes are excluded, may require treatment as consideration for complication of immunotherapy.
Identifiants
pubmed: 36905577
pii: 7076255
doi: 10.1093/oncolo/oyad031
pmc: PMC10400162
doi:
Substances chimiques
Immune Checkpoint Inhibitors
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
706-713Informations de copyright
© The Author(s) 2023. Published by Oxford University Press.
Références
Clin Gastroenterol Hepatol. 2016 Jun;14(6):836-842
pubmed: 26748223
Ann Oncol. 2017 Nov 01;28(11):2860-2865
pubmed: 29045560
Medicine (Baltimore). 2020 Jan;99(5):e18927
pubmed: 32000406
N Engl J Med. 2010 Aug 19;363(8):711-23
pubmed: 20525992
Dig Dis. 2016;34(3):210-6
pubmed: 27028228
N Engl J Med. 2012 Jun 28;366(26):2443-54
pubmed: 22658127
Proc Natl Acad Sci U S A. 2003 Apr 15;100(8):4712-7
pubmed: 12682289
Arch Pathol Lab Med. 2021 Feb 1;145(2):191-200
pubmed: 33501492
N Engl J Med. 2015 May 21;372(21):2018-28
pubmed: 25891174
Intern Med. 2017;56(6):743-744
pubmed: 28321083
Ann Oncol. 2015 Dec;26(12):2375-91
pubmed: 26371282
Virchows Arch. 2018 Nov;473(5):533-550
pubmed: 30255340
Semin Diagn Pathol. 2014 Mar;31(2):114-23
pubmed: 24815937
Nat Rev Cancer. 2012 Mar 22;12(4):252-64
pubmed: 22437870
Ann Oncol. 2016 Jul;27(7):1199-206
pubmed: 27122549
J Immunother Cancer. 2019 Aug 22;7(1):226
pubmed: 31439050
Cancer Immunol Immunother. 2017 May;66(5):581-592
pubmed: 28204866
J Natl Med Assoc. 2010 May;102(5):419-22
pubmed: 20533777
Rheumatology (Oxford). 2019 Dec 1;58(Suppl 7):vii59-vii67
pubmed: 31816080
Histopathology. 2020 Jan;76(2):233-243
pubmed: 31361907
Scand J Gastroenterol. 2019 May;54(5):538-545
pubmed: 31079556
Histopathology. 2020 Mar;76(4):531-539
pubmed: 31692018