The most common organs affected by toxicities from checkpoint inhibitor immunotherapy (IrAEs) are in the gastrointestinal system. Patients experience high rates of hepatitis, pancreatitis and entero colitis both with PD-1 inhibitors and particularly with CTLA-4 inhibitors. The rate and severity of IrAEs are particularly high in those treated with a combination of CTLA-4 and PD-1 blockade. These complications are not only frequent but some are severe and they can delay or prevent further immunotherapy. The occurrence of toxicities and their treatment may impact on oncological outcomes.
Whilst the majority of the gastrointestinal toxicities are mild-moderate in severity and respond to corticosteroids there are a significant proportion with severe toxicities. Managing more severe toxicities requires careful assessment and timely administration of effective therapies. Care needs to be taken to prevent complications from steroid and non-steroidal immunosuppression.
Gastrointestinal IrAEs already represents a significant issue for patients and a burden on the health-care system. The size of this problem is only going to increase as the use and indication for immunotherapy expands. Hence it is important that both oncologists and gastroenterologists to understand how to assess and manage gastrointestinal toxicities of Checkpoint inhibitors.
In this session I will discuss the risks of gastrointestinal toxicities. I will explore management strategies and the evidence behind them. I will discuss risk stratification and prognostication. I will also address some of the practical issues that impact on the management of this conditions in the Australian health care system including the importance of collaboration between oncologists and gastroenterologists. Lastly, I will also take a look into the future of this rapidly evolving and important field into factors that predict or predispose patients to these toxicities and how our management strategies may evolve into the future.