Gastroparesis Following Immune Checkpoint Inhibitor Therapy: A Case Series

Overview

Journal Dig Dis Sci

Specialty Gastroenterology

Date 2020 Jun 29

PMID 32594464

Citations 2

Authors

Jessica Atieh

Jordan Sack

Richard Thomas

Osama E Rahma

Michael Camilleri

Shilpa Grover

Affiliations

Soon will be listed here.

Abstract

Background: Immune checkpoint inhibitors (ICI) have improved outcomes in patients with various malignancies; however, they can cause immune-related hepatitis and enterocolitis. Patients on ICI may also develop upper gastrointestinal symptoms and undergo measurement of gastric emptying.

Aims: Our aim was to review records of patients with gastroparesis following ICI therapy at two medical centers.

Methods: We performed a retrospective review of all patients at Mayo Clinic and Brigham and Women's/Dana-Farber Cancer Center (BWH/DFCC) who underwent gastric scintigraphy for the assessment of symptoms of gastroparesis following ICI treatment up to January 2020. Clinical presentation, medical history, laboratory evaluation, imaging, treatment, and outcomes were retrieved from the records. Gastroparesis was diagnosed as delayed gastric emptying (GE) measured by gastric scintigraphy.

Results: At Mayo Clinic, 2 patients (median age 59 years, 1 male [M], 1 female [F]) had delayed GE, while 4 patients (median age 53 years, 3M, 1F) had normal GE following ICI use. Of those with delayed GE (diagnosed after 38 and 2 months of ICI initiation), 1 patient was treated for non-Hodgkin's lymphoma and melanoma with ipilimumab; a second patient with breast cancer was treated with pembrolizumab. At BWH/DFCC, 2 patients (median age 56 years, 1M, 1F) had normal GE after ICI treatment, while a 62-year-old female with non-small cell lung cancer developed gastroparesis 3 months following initiation of nivolumab.

Conclusion: This report documents gastroparesis as a potential adverse effect of ICI. Further studies should explore the potential for ICI therapy to damage anti-inflammatory macrophages that preserve the enteric neurons.

Citing Articles

Systematic review of immune checkpoint inhibitor-related gastrointestinal, hepatobiliary, and pancreatic adverse events.

Shatila M, Zhang H, Thomas A, Machado A, Naz S, Mittal N J Immunother Cancer. 2024; 12(11).

PMID: 39542654 PMC: 11575294. DOI: 10.1136/jitc-2024-009742.

The Effect of Immune Checkpoint Inhibitor Therapy on Pre-Existing Gastroparesis and New Onset of Symptoms of Delayed Gastric Emptying.

Urias Rivera A, Machado A, Shatila M, Triadafilopoulos G, McQuade J, Altan M Cancers (Basel). 2024; 16(15).

PMID: 39123385 PMC: 11311627. DOI: 10.3390/cancers16152658.

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