SOP Maßnahmen bei Diarrhö unter Therapie mit Checkpoint-Inhibitoren

Checkpoint-Inhibitoren sind ein wichtiger Baustein vieler Tumortherapien, bei deren Einsatz es zum Auftreten immunvermittelter Nebenwirkungen kommen kann. Bei der gastrointestinalen Toxizität stehen Diarrhö und Kolitis im Vordergrund. Dieser Beitrag widmet sich den diagnostischen und therapeutischen Maßnahmen, die möglichst frühzeitig eingeleitet werden sollten, um schwere Komplikationen zu vermeiden.

Schlüsselwörter

Immuntherapie-vermittelte Diarrhoe - Checkpoint-Inhibitoren - Glukokortikoide

Publication History

Article published online:
03 April 2023

• Literatur

• 1 Som A, Mandaliya R, Alsaadi D. et al. Immune checkpoint inhibitor-induced colitis: A comprehensive review. World J Clin Case 2019; 7: 405-418 DOI: 10.12998/wjcc.v7.i4.405. (PMID: 30842952)
• 2 Dougan M, Blidner AG, Choi J. et al. Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management of severe gastrointestinal and hepatic toxicities from checkpoint inhibitors. Support Care Cancer 2020; 28: 6129-6143 DOI: 10.1007/s00520-020-05707-3.
• 3 Schneider BJ, Naidoo J, Santomasso BD. et al. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update. J Clin Oncol 2021; 39: 4073-4126 DOI: 10.1200/JCO.21.01440.
• 4 Kumar V, Chaudhary N, Garg M. et al. Current diagnosis and management of immune related adverse events (irAEs) induced by immune checkpoint inhibitor therapy. Front Pharmacol 2017; 8: 49 DOI: 10.3389/fphar.2017.00049. (PMID: 28228726)
• 5 Haanen JBAG, Carbonnel F, Robert C. et al. Management of toxicities from immunotherapy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017; 28 (Suppl. 04) iv119-iv142 DOI: 10.1093/annonc/mdx225.
• 6 Wang Y, Abu-Sbeih H, Mao E. et al. Endoscopic and histologic features of immune checkpoint inhibitor-related colitis. Inflamm Bowel Dis 2018; 24: 1695-1705 DOI: 10.1093/ibd/izy104. (PMID: 29718308)
• 7 Abu-Sbeih H, Tang T, Ali FS. et al. The impact of immune checkpoint inhibitor-related adverse events and their immunosuppressive treatment on patients’ outcomes. J Immunother Precis Oncol 2018; 1: 7-18 DOI: 10.4103/JIPO.JIPO_12_18.
• 8 Esfahani K, Hudson M, Batist G. Tofacitinib for refractory immune-related colitis from PD-1 therapy. N Engl J Med 2020; 382: 2374-2375 DOI: 10.1056/NEJMc2002527. (PMID: 32521140)
• 9 Thomas AS, Ma W, Wang Y. et al. Ustekinumab for refractory colitis associated with immune checkpoint inhibitors. N Eng J Med 2021; 384: 581-583 DOI: 10.1056/NEJMc2031717.
• 10 Marthey L, Mateus C, Mussini C. et al. Cancer immunotherapy with anti-CTLA-4 monoclonal antibodies induces an inflammatory bowel disease. J Crohns Colitis 2016; 10: 395-401 DOI: 10.1093/ecco-jcc/jjv227.