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Small bowel villous atrophy due to immune-checkpoint inhibitors: report of two cases and literature review

The differential diagnosis of non-coeliac enteropathies (NCEs) is challenging and includes a wide range of aetiologies. Drug-induced NCEs are relatively common and characterized by duodenal villous atrophy, which resolves upon suspension of the offending drug. Immune-checkpoint inhibitors (ICIs), ta...

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Autores principales: Schiepatti, Annalisa, Premoli, Andrea, Maimaris, Stiliano, Rizzo, Mimma, Marples, Maria, Villani, Laura, Scott, Nigel, Sottotetti, Federico, Sanders, David S, Biagi, Federico, Donnellan, Clare
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioExcel Publishing Ltd 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9616105/
https://www.ncbi.nlm.nih.gov/pubmed/36339292
http://dx.doi.org/10.7573/dic.2022-6-3
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author Schiepatti, Annalisa
Premoli, Andrea
Maimaris, Stiliano
Rizzo, Mimma
Marples, Maria
Villani, Laura
Scott, Nigel
Sottotetti, Federico
Sanders, David S
Biagi, Federico
Donnellan, Clare
author_facet Schiepatti, Annalisa
Premoli, Andrea
Maimaris, Stiliano
Rizzo, Mimma
Marples, Maria
Villani, Laura
Scott, Nigel
Sottotetti, Federico
Sanders, David S
Biagi, Federico
Donnellan, Clare
author_sort Schiepatti, Annalisa
collection PubMed
description The differential diagnosis of non-coeliac enteropathies (NCEs) is challenging and includes a wide range of aetiologies. Drug-induced NCEs are relatively common and characterized by duodenal villous atrophy, which resolves upon suspension of the offending drug. Immune-checkpoint inhibitors (ICIs), targeting molecules involved in the activation of cytotoxic T cells by targeting, for example, PD-1, PD-L1 and CTLA4, are increasingly used for many types of cancers. Adverse events occurring in the gastrointestinal tract have been described, predominantly in the form of immune-mediated colitis mimicking inflammatory bowel disease. Small bowel involvement whilst on ICI therapy is also possible, though less well described. Herein, we describe two cases of enteropathy with villous atrophy and negative coeliac serology due to ICIs: a 65-year-old man affected by stage IV pulmonary adenocarcinoma under treatment with pembrolizumab and an 18-year-old woman affected by stage IV auricular melanoma who was treated with nivolumab. We also provide a review of the current literature describing small bowel involvement during therapy with ICIs, alone or in combination, for different types of solid tumours. Implications for clinical practice include considering the possibility of small bowel involvement in oncological patients treated with ICIs and the inclusion of ICIs amongst the iatrogenic causes of NCE with villous atrophy. Enteropathies due to ICIs may also represent a pathogenetic model for the understanding of the molecular mechanisms leading to villous atrophy in NCE.
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spelling pubmed-96161052022-11-04 Small bowel villous atrophy due to immune-checkpoint inhibitors: report of two cases and literature review Schiepatti, Annalisa Premoli, Andrea Maimaris, Stiliano Rizzo, Mimma Marples, Maria Villani, Laura Scott, Nigel Sottotetti, Federico Sanders, David S Biagi, Federico Donnellan, Clare Drugs Context Case Report The differential diagnosis of non-coeliac enteropathies (NCEs) is challenging and includes a wide range of aetiologies. Drug-induced NCEs are relatively common and characterized by duodenal villous atrophy, which resolves upon suspension of the offending drug. Immune-checkpoint inhibitors (ICIs), targeting molecules involved in the activation of cytotoxic T cells by targeting, for example, PD-1, PD-L1 and CTLA4, are increasingly used for many types of cancers. Adverse events occurring in the gastrointestinal tract have been described, predominantly in the form of immune-mediated colitis mimicking inflammatory bowel disease. Small bowel involvement whilst on ICI therapy is also possible, though less well described. Herein, we describe two cases of enteropathy with villous atrophy and negative coeliac serology due to ICIs: a 65-year-old man affected by stage IV pulmonary adenocarcinoma under treatment with pembrolizumab and an 18-year-old woman affected by stage IV auricular melanoma who was treated with nivolumab. We also provide a review of the current literature describing small bowel involvement during therapy with ICIs, alone or in combination, for different types of solid tumours. Implications for clinical practice include considering the possibility of small bowel involvement in oncological patients treated with ICIs and the inclusion of ICIs amongst the iatrogenic causes of NCE with villous atrophy. Enteropathies due to ICIs may also represent a pathogenetic model for the understanding of the molecular mechanisms leading to villous atrophy in NCE. BioExcel Publishing Ltd 2022-10-21 /pmc/articles/PMC9616105/ /pubmed/36339292 http://dx.doi.org/10.7573/dic.2022-6-3 Text en Copyright © 2022 Schiepatti A, Premoli A, Maimaris S, Rizzo M, Marples M, Villani L, Scott N, Sottotetti F, Sanders DS, Biagi F, Donnellan C https://creativecommons.org/licenses/by-nc-nd/4.0/Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0, which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.
spellingShingle Case Report
Schiepatti, Annalisa
Premoli, Andrea
Maimaris, Stiliano
Rizzo, Mimma
Marples, Maria
Villani, Laura
Scott, Nigel
Sottotetti, Federico
Sanders, David S
Biagi, Federico
Donnellan, Clare
Small bowel villous atrophy due to immune-checkpoint inhibitors: report of two cases and literature review
title Small bowel villous atrophy due to immune-checkpoint inhibitors: report of two cases and literature review
title_full Small bowel villous atrophy due to immune-checkpoint inhibitors: report of two cases and literature review
title_fullStr Small bowel villous atrophy due to immune-checkpoint inhibitors: report of two cases and literature review
title_full_unstemmed Small bowel villous atrophy due to immune-checkpoint inhibitors: report of two cases and literature review
title_short Small bowel villous atrophy due to immune-checkpoint inhibitors: report of two cases and literature review
title_sort small bowel villous atrophy due to immune-checkpoint inhibitors: report of two cases and literature review
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9616105/
https://www.ncbi.nlm.nih.gov/pubmed/36339292
http://dx.doi.org/10.7573/dic.2022-6-3
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