Enterocolitis y otras manifestaciones de toxicidad gastrointestinal asociada a inmunoterapia y terapia blanco: una revisión para el gastroenterólogo

Newer oncologic therapies, particularly immunotherapy (IT), have been a game-changer for the treatment of advanced cancer. The so-called checkpoint inhibitors act by increasing T cell activity and individual immune response against neoplastic cells. Targeted therapy is another form of IT that acts by inhibiting oncogenes or tumor-related inflammatory and angiogenesis pathways. However, these tumor-destruction mechanisms may interfere with host self-tolerance or with normal tissue repair mechanisms and increase the risk of immune-related adverse events that may affect multiple organs, including the digestive system. Gastrointestinal toxicity ranges from mild forms of mucositis, ulcerations, and in severe cases, to necrosis and perforation, and may affect any part of the GI tract, with a predominance of enterocolonic damage, similar to that seen in inflammatory bowel disease. The most common clinical manifestation is chronic diarrhea. Differential diagnosis includes opportunistic enteropathogen-associated diarrhea, particularly opportunistic agents, drug adverse effects, and other inflammatory and malabsorptive entities. Treatment varies according to the grade of toxicity and may include antidiarrheal medication and outpatient rehydration in mild cases, systemic steroids, and temporary withdrawal of IT in moderate forms, and immunosuppressant or biologic agents, as well as definitive withdrawal of IT, in severe cases.