Faculty, Staff and Student Publications
Language
English
Publication Date
12-1-2023
Journal
Journal of Cancer Research and Clinical Oncology
DOI
10.1007/s00432-023-05461-z
PMID
37917197
PMCID
PMC11796862
PubMedCentral® Posted Date
11-2-2023
PubMedCentral® Full Text Version
Post-print
Abstract
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.
Keywords
Adult, Humans, Middle Aged, Immune Checkpoint Inhibitors, Retrospective Studies, Antineoplastic Agents, Immunological, Neoplasms, Anti-Bacterial Agents, Pneumatosis intestinalis, Immune-related adverse event, Immune checkpoint inhibitor, Anti-CTLA-4, Anti-PD-1/L1
Published Open-Access
yes
Recommended Citation
Sperling, Gabriel; Shatila, Malek; Varatharajalu, Krishnavathan; et al., "Pneumatosis Intestinalis in Cancer Patients Who Received Immune Checkpoint Inhibitors" (2023). Faculty, Staff and Student Publications. 1313.
https://digitalcommons.library.tmc.edu/uthsph_docs/1313