V．免疫チェックポイント阻害薬による大腸炎
免疫チェックポイント阻害薬（immune-checkpoint inhibitors：ICI）が悪性腫瘍の標準治療となるに伴い，免疫関連有害事象（immune-related adverse events：irAE）が注目されている．全身諸臓器の中で，消化管はirAEの好発部位であり，なかでも大腸が最も高率である．ICI関連大腸炎の内視鏡所見は血管透見の消失，顆粒状粘膜，発赤，粘液付着，浮腫性粘膜，びらん，潰瘍などであり，病理学的所見として粘膜固有層の拡張，好中球の上皮内浸潤，陰窩の歪み，陰窩膿瘍および顕著なアポトーシスが認められる．このように，ICI関連大腸炎の診断には内視鏡検査と生検が必須...
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| Published in | 日本大腸肛門病学会雑誌 Vol. 74; no. 10; pp. 599 - 605 |
|---|---|
| Main Authors | , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本大腸肛門病学会
2021
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0047-1801 1882-9619 |
| DOI | 10.3862/jcoloproctology.74.599 |
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| Abstract | 免疫チェックポイント阻害薬（immune-checkpoint inhibitors：ICI）が悪性腫瘍の標準治療となるに伴い，免疫関連有害事象（immune-related adverse events：irAE）が注目されている．全身諸臓器の中で，消化管はirAEの好発部位であり，なかでも大腸が最も高率である．ICI関連大腸炎の内視鏡所見は血管透見の消失，顆粒状粘膜，発赤，粘液付着，浮腫性粘膜，びらん，潰瘍などであり，病理学的所見として粘膜固有層の拡張，好中球の上皮内浸潤，陰窩の歪み，陰窩膿瘍および顕著なアポトーシスが認められる．このように，ICI関連大腸炎の診断には内視鏡検査と生検が必須であるが，重症度は患者により大きく異なる．また，副腎皮質ステロイドや生物学的製剤などの免疫制御療法を要する重症例も存在するため，本症を見逃さないことが重要である． |
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| AbstractList | 免疫チェックポイント阻害薬（immune-checkpoint inhibitors：ICI）が悪性腫瘍の標準治療となるに伴い，免疫関連有害事象（immune-related adverse events：irAE）が注目されている．全身諸臓器の中で，消化管はirAEの好発部位であり，なかでも大腸が最も高率である．ICI関連大腸炎の内視鏡所見は血管透見の消失，顆粒状粘膜，発赤，粘液付着，浮腫性粘膜，びらん，潰瘍などであり，病理学的所見として粘膜固有層の拡張，好中球の上皮内浸潤，陰窩の歪み，陰窩膿瘍および顕著なアポトーシスが認められる．このように，ICI関連大腸炎の診断には内視鏡検査と生検が必須であるが，重症度は患者により大きく異なる．また，副腎皮質ステロイドや生物学的製剤などの免疫制御療法を要する重症例も存在するため，本症を見逃さないことが重要である． |
| Author | 菅井, 有 梁井, 俊一 松本, 主之 |
| Author_xml | – sequence: 1 fullname: 菅井, 有 organization: 岩手医科大学病理診断学講座 – sequence: 1 fullname: 梁井, 俊一 organization: 岩手医科大学内科学講座消化器内科消化管分野 – sequence: 1 fullname: 松本, 主之 organization: 岩手医科大学内科学講座消化器内科消化管分野 |
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| ContentType | Journal Article |
| Copyright | 2021 日本大腸肛門病学会 |
| Copyright_xml | – notice: 2021 日本大腸肛門病学会 |
| DOI | 10.3862/jcoloproctology.74.599 |
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JAMA Oncol 2:234-240, 2016 55) Chen JH, Pezhouh MK, Lauwers GY, et al: Histopathologic features of colitis due to immunotherapy with anti-PD-1 antibodies. Am J Surg Pathol 41:643-654, 2017 12) Bellaguarda E, Hanauer S: Checkpoint inhibitor-induced colitis. Am J Gastroenterol 115:202-210, 2020 46) Verschuren EC, van den Eertwegh AJ, Wonders J, et al: Clinical, endoscopic, and histologic characteristic of ipilimumab-associated colitis. Clin Gastroenterol Hepatol 14:836-842, 2016 22) Yasuda Y, Urata Y, Tohnai R, et al: Immune-related colitis induced by the long-term use of nivolumab in a patient with non-small cell lung cancer. Intern Med 57:1269-1272, 2018 61) Haanen JBAG, Carbonnel F, Robert C, et al: Management of toxicities from immunotherapy: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. 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| References_xml | – reference: 55) Chen JH, Pezhouh MK, Lauwers GY, et al: Histopathologic features of colitis due to immunotherapy with anti-PD-1 antibodies. Am J Surg Pathol 41:643-654, 2017 – reference: 60) Baroudjian B, Lourenco N, Pages C, et al: Anti-PD1-induced collagenous colitis in a melanoma patient. Melanoma Res 26:308-311, 2016 – reference: 31) McDermott DF, Atkins MB: PD-1 as a potential target in cancer therapy. Cancer Med 2:662-673, 2013 – reference: 56) Karamchandani DM, Chetty R: Immune checkpoint inhibitor-induced gastrointestinal and hepatic injury: pathologists' perspective. J Clin Pathol 71:665-671, 2018 – reference: 11) Soularue E, Lepage P, Colombel JF, et al: Enterocolitis due to immune checkpoint inhibitors: a systematic review. Gut 67:2056-2067, 2018 – reference: 54) Wright A, Piper MS, Bishu A, et al: Systematic review and case series: flexible sigmoidoscopy identifies most cases of checkpoint inhibitor-induced colitis. Aliment Pharmacol Ther 49:1474-1483, 2019 – reference: 30) West NR, Powrie KS: Immunotherapy not working? Check your microbiota. Cancer Cell 28:687-689, 2015 – reference: 63) Brahmer JR, Lacchetti C, Schneider BJ, et al: Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 36:1714-1768, 2018 – reference: 8) Wang DY, Salem JE, Cohen JV, et al: Fatal toxic effects associated with immune checkpoint inhibitors: a systematic review and meta-analysis. JAMA Oncol 4:1721-1728, 2018 – reference: 62) Puzanov I, Diab A, Adballah K, et al: Managing toxicities associated with immune checkpoint inhibitors: consensus recommendations from the Society for Immunotherapy of Cancer (SITC) Toxicity Management Working Group. J Immunother Cancer 5:95, 2017 – reference: 50) Wang Y, Abu-Sbeih H, Mao E, et al: Endoscopic and histologic features of immune checkpoint inhibitor-related colitis. Inflamm Bowel Dis 24:1695-1705, 2018 – reference: 13) Dougan M, Wang Y, Rubin-Tapia A, et al: AGA clinical practice update on diagnosis and management of immune checkpoint inhibitor colitis and hepatitis: expert review. Gastroenterology 160:1284-1293, 2021 – reference: 53) Mooradian MJ, Wang DY, Coromilas A, et al: Mucosal inflammation predicts response to systemic steroids in immune checkpoint inhibitor colitis. J Immunother Cancer 8:e000451, 2020 – reference: 22) Yasuda Y, Urata Y, Tohnai R, et al: Immune-related colitis induced by the long-term use of nivolumab in a patient with non-small cell lung cancer. Intern Med 57:1269-1272, 2018 – reference: 49) Abu-Sbeih H, Ali FS, Luo W, et al: Importance of endoscopic and histological evaluation in the management of immune checkpoint inhibitor-induced colitis. J Immunother Cancer 6:95, 2018 – reference: 57) Alder BL, Pezhouh MK, Kim A, et al: Histopathological and immunophenotypic features of ipilimumab-associated colitis compared to ulcerative colitis. J Intern Med 283:568-577, 2018 – reference: 3) Topalian SL, Hodi FS, Brahmer JR, et al: Safety, activity, and immune correlates of anti-PD-1 antibody in cancer. N Engl J Med 366:2443-2454, 2012 – reference: 29) Korman AJ, Peggs KS, Allison JP: Checkpoint blockade in cancer immunotherapy. Adv Immunol 90:297-339, 2006 – reference: 45) Cheng R, Cooper A, Kench J, et al: Ipilimumab-induced toxicities and the gastroenterologist. J Gastroenterol Hepatol 30:657-666, 2015 – reference: 2) Ascierto PA, Del Vecchio M, Robert C, et al: Ipilimumab 10 mg/kg versus ipilimumab 3 mg/kg in patients with unresectable or metastatic melanoma: a randomized, double-blind, multicenter, phase 3 trial. Lancet Oncol 18:611-622, 2017 – reference: 41) Kahler KC, Eigentler TK, Gesierich A, et al: Ipilimumab in metastatic melanoma patients with pre-existing autoimmune disorder. Cancer Immunology, Immunotherapy 67:825-834, 2018 – reference: 25) 櫻井俊治, 樫田博史, 永井知行ほか:免疫チェックポイント阻害薬による大腸病変. 消化器内視鏡 31:928-933, 2019 – reference: 7) Khoja L, Day D, Wei-Wu Chen T, et al: Tumor- and class-specific patterns of immune-related adverse events of immune checkpoint inhibitors: a systemic review. Ann Oncol 28:2377-2385, 2017 – reference: 33) US Department of Health and Human Services: Common Terminology Criteria for Adverse Events. National Institutes of Health, National Cancer Institute, 2017 Version 5 – reference: 9) Abdel-Wahab N, Shah M, Suarez-Almazor ME: Adverse events associated with immune checkpoint blockade in patients with cancer: a systematic review of case reports. PLoS One 11:e0160221, 2016 – reference: 23) Kikuchi H, Sakuraba H, Akemoto Y, et al: A case of nivolumab-associated colitis, which relapsed after mucosal healing and was then successfully treated with mesalazine. Immunol Med 42:39-44, 2019 – reference: 28) Kunogi Y, Tominaga K, Abe K, et al: Refractory immune checkpoint inhibitor-induced colitis improved by tacrolimus: A case report. Healthcare 9:418, 2019 – reference: 43) Beck KE, Blansfield JA, Tran KQ, et al: Enterocolitis in patients with cancer after antibody blockade of cytotoxic T-lymphocyte-associated antigen 4. J Clin Oncol 24:2283-2289, 2006 – reference: 32) Assarzadegan N, Montgomery E, Anders RA: Immune checkpoint inhibitor colitis: the flip side of the wonder drugs. Virchows Arch 472:125-133, 2018 – reference: 36) Tandon P, Bourassa-Blanchette S, Bishay K, et al: The risk of diarrhea and colitis in patients with advanced melanoma undergoing immune checkpoint inhibitor therapy: a systematic review and meta-analysis. J Immunother 41:101-108, 2018 – reference: 18) Abe K, Nakamura N, Isono A, et al: Inflammatory bowel disease in an elderly woman after nivolumab administration. Am J Gastroenterol 112:1636, 2017 – reference: 48) Collins M, Michot JM, Danlos FX, et al: Inflammatory gastrointestinal disease associated with PD-1 blockade antibodies. Ann Oncol 28:2860-2865, 2017 – reference: 15) Kubo K, Kato M, Mabe K: Nivolumab-associated colitis mimicking ulcerative colitis. Clin Gastroenterol Hepatol 15:A35-A36, 2017 – reference: 39) Abu-Sbeih H, Faleck DM, Ricciuti B, et al: Immune checkpoint inhibitor therapy in patients with preexisting inflammatory bowel disease. J Clin Oncol 38:576-583, 2020 – reference: 26) Yanai S, Nakamura S, Kawasaki K, et al: Immune checkpoint inhibitor-induced diarrhea: Clinicopathological study of 11 patients. Dig Endosc 32:616-620, 2020 – reference: 1) Hodi FS, O'Day SJ, McDermott DF, et al: Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med 363:711-723, 2010 – reference: 34) Cheung VTF, Gupta T, Olssopn-Brown A, et al: Immune checkpoint inhibitor-related colitis assessment and prognosis: can IBD scoring point the way? Br J Cancer 123:207-215, 2020 – reference: 59) Kubo T, Hirohashi Y, Keira Y, et al: Identification of characteristic subepithelial surface granulomatosis in immune-related adverse event-associated enterocolitis. Cancer Sci 112:1320-1325, 2021 – reference: 42) Geukes Foppen MH, Rozeman EA, van Wilpe S, et al: Immune checkpoint inhibition-related colitis: symptoms, endoscopic features, histology and response to management. ESMO Open 3:e000278, 2018 – reference: 5) Weber JS, Gibney G, Sullivan RJ, et al: Sequential administration of nivolumab and ipilimumab with a planned switch in patients with advanced melanoma (CheckMate 064) : an open-label, randomised, phase 2 trial. 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| Snippet | 免疫チェックポイント阻害薬（immune-checkpoint inhibitors：ICI）が悪性腫瘍の標準治療となるに伴い，免疫関連有害事象（immune-related adverse events：irAE）が注... |
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| SubjectTerms | 免疫チェックポイント阻害薬 免疫関連有害事象 大腸炎 |
| Title | V．免疫チェックポイント阻害薬による大腸炎 |
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