Inflammatory bowel disease and cancer response due to anti-CTLA-4: is it in the flora?

Semin Immunopathol. 2017 Apr;39(3):327-331. doi: 10.1007/s00281-016-0613-x. Epub 2017 Jan 16.

Abstract

Checkpoint inhibitors blocking CTLA-4 (ipilimumab) and PD-1 (nivolumab, pembrolizumab) have transfigured our cancer treatment paradigm. However, these drugs can induce immune-related adverse events that share clinical and pathological characteristics with immune-mediated diseases. One of the most severe immune-related adverse event observed with anti-CTLA-4 is an enterocolitis that mirrors naturally occurring inflammatory bowel disease. This paper reviews the clinical, immunological, and microbiota data associated with the immune-related enterocolitis induced by the cancer immunotherapy blocking CTLA-4, ipilimumab. A parallel analysis of the mechanisms underlying inflammatory bowel diseases on the one hand, and anti-CTLA-4-induced colitis on the other hand, stresses the crucial role of the gut microbiota and of resident Treg in the genesis of both iatrogenic and spontaneous inflammatory bowel diseases.

Publication types

  • Review

MeSH terms

  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Monoclonal / adverse effects*
  • Antibodies, Monoclonal / therapeutic use*
  • CTLA-4 Antigen / antagonists & inhibitors*
  • Colitis / etiology
  • Humans
  • Immunomodulation / drug effects
  • Immunotherapy / adverse effects
  • Immunotherapy / methods
  • Inflammatory Bowel Diseases / etiology*
  • Inflammatory Bowel Diseases / metabolism
  • Intestinal Mucosa / metabolism
  • Intestines / immunology
  • Ipilimumab
  • Molecular Targeted Therapy / adverse effects
  • Neoplasms / complications*
  • Neoplasms / drug therapy*
  • Neoplasms / metabolism

Substances

  • Antibodies, Monoclonal
  • CTLA-4 Antigen
  • Ipilimumab