TY - JOUR
T1 - Pneumatosis intestinalis in cancer patients who received immune checkpoint inhibitors
AU - Sperling, Gabriel
AU - Shatila, Malek
AU - Varatharajalu, Krishnavathan
AU - Lu, Yang
AU - Altan, Mehmet
AU - Zhou, Yan
AU - Zhao, Dan
AU - De Toni, Enrico N.
AU - Török, Helga Paula
AU - Schneider, Bryan J.
AU - Khan, Anam
AU - Thomas, Anusha S.
AU - Zhang, Hao Chi
AU - Shafi, Mehnaz A.
AU - Wang, Yinghong
N1 - Publisher Copyright:
© 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2023/12
Y1 - 2023/12
N2 - Purpose: Immune checkpoint inhibitor (ICI) therapy may give rise to immune-related adverse events (irAEs). Pneumatosis intestinalis (PI), or gas within the bowel wall, has very rarely been observed following ICI therapy, and its clinical significance is unclear. We described the clinical characteristics and outcomes of PI as a possible irAE in cancer patients. Methods: We retrospectively identified 12 adult cancer patients with radiologic evidence of PI within 1 year after ICI exposure during January 2010–January 2023. Clinical characteristics, treatment, and outcomes were evaluated. Results: The median age of our sample was 64 years. The most common cancer types were thoracic/head & neck and gastrointestinal. Eleven patients (92%) received anti-PD-1/L1 monotherapy, while 1 patient (8%) received a combination of anti-PD-1/L1 and anti-CTLA-4. PI occurred a median of 7 months after the first ICI dose. Half the patients (50%) were asymptomatic on diagnosis, and the most common presenting symptom was abdominal pain (42%). Six patients experienced complications, namely pneumoperitoneum (n = 6, 50%) and microperforation (n = 1, 8%), identified on imaging. Nine patients were treated with antibiotics and 3 patients were monitored conservatively. Nine patients (75%) resumed cancer treatment after PI. Conclusion: PI may develop as an irAE. While half of cases were incidental radiologic findings, management with antibiotics as well as hospitalization for observation may still be appropriate. The decision to restart cancer therapy and possibly resume ICI therapy remains to be elucidated. Further large-scale studies may be warranted to clarify the association between PI and ICI therapy.
AB - Purpose: Immune checkpoint inhibitor (ICI) therapy may give rise to immune-related adverse events (irAEs). Pneumatosis intestinalis (PI), or gas within the bowel wall, has very rarely been observed following ICI therapy, and its clinical significance is unclear. We described the clinical characteristics and outcomes of PI as a possible irAE in cancer patients. Methods: We retrospectively identified 12 adult cancer patients with radiologic evidence of PI within 1 year after ICI exposure during January 2010–January 2023. Clinical characteristics, treatment, and outcomes were evaluated. Results: The median age of our sample was 64 years. The most common cancer types were thoracic/head & neck and gastrointestinal. Eleven patients (92%) received anti-PD-1/L1 monotherapy, while 1 patient (8%) received a combination of anti-PD-1/L1 and anti-CTLA-4. PI occurred a median of 7 months after the first ICI dose. Half the patients (50%) were asymptomatic on diagnosis, and the most common presenting symptom was abdominal pain (42%). Six patients experienced complications, namely pneumoperitoneum (n = 6, 50%) and microperforation (n = 1, 8%), identified on imaging. Nine patients were treated with antibiotics and 3 patients were monitored conservatively. Nine patients (75%) resumed cancer treatment after PI. Conclusion: PI may develop as an irAE. While half of cases were incidental radiologic findings, management with antibiotics as well as hospitalization for observation may still be appropriate. The decision to restart cancer therapy and possibly resume ICI therapy remains to be elucidated. Further large-scale studies may be warranted to clarify the association between PI and ICI therapy.
KW - Anti-CTLA-4
KW - Anti-PD-1/L1
KW - Immune checkpoint inhibitor
KW - Immune-related adverse event
KW - Pneumatosis intestinalis
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U2 - 10.1007/s00432-023-05461-z
DO - 10.1007/s00432-023-05461-z
M3 - Article
C2 - 37917197
AN - SCOPUS:85175582657
SN - 0171-5216
VL - 149
SP - 17597
EP - 17605
JO - Journal of cancer research and clinical oncology
JF - Journal of cancer research and clinical oncology
IS - 19
ER -