Histopathologic Manifestations of Immune Checkpoint Inhibitor Therapy-Associated Gastrointestinal Tract Injury: A Practical Review

James Michael Mitchell; Dipti M Karamchandani

doi:10.1016/j.path.2023.05.007

Histopathologic Manifestations of Immune Checkpoint Inhibitor Therapy-Associated Gastrointestinal Tract Injury: A Practical Review

Surg Pathol Clin. 2023 Dec;16(4):703-718. doi: 10.1016/j.path.2023.05.007. Epub 2023 Jun 26.

Authors

James Michael Mitchell¹, Dipti M Karamchandani²

Affiliations

¹ Department of Pathology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA. Electronic address: https://twitter.com/GIJamesMD.
² Department of Pathology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA. Electronic address: dipti.karamchandani@utsouthwestern.edu.

PMID: 37863561
DOI: 10.1016/j.path.2023.05.007

Abstract

Immune checkpoint inhibitors have revolutionized the management of many advanced cancers by producing robust remissions. They mostly target two immune regulatory pathways: cytotoxic T lymphocyte antigen-4 and programmed death-1 or its ligand. However, a flip side is the immune-related adverse events (irAEs) commonly affecting the gastrointestinal (GI) tract that can cause treatment interruptions or discontinuation. This practical review discusses the clinical and histopathologic findings of irAEs encountered in the luminal GI tract, along with histopathologic differentials that can mimic varied inflammatory, infectious, or other medication-associated etiologies and the importance of clinico-pathologic correlation for an accurate diagnosis.

Keywords: Cytotoxic T lymphocyte antigen (CTLA)-4; Immune checkpoint inhibitors; Immune-related adverse events; Programmed death (PD)-1; Programmed death ligand (PD-L1).

Publication types

Review

MeSH terms

Gastrointestinal Tract
Humans
Immune Checkpoint Inhibitors* / adverse effects
Neoplasms*

Substances

Immune Checkpoint Inhibitors