Les entérocolites aux inhibiteurs de point de contrôle immunitaire.

Immunotherapy in cancer is coming of age. Immune checkpoint inhibitors (ICI), namely anti-CTLA4 and anti-PD1 antibodies, can lead to immune-related adverse events which may affect gastro-intestinal tract. Enterocolitis is frequent and potentially serious. It is characterized by diarrhea associated with abdominal pain, more rarely hematochezia. Toxic megacolon or colonic perforation may occur, particularly when treatment is delayed. Diagnosis is confirmed by colonoscopy or flexible sigmoidoscopy and biopsies. Infectious colitis, intestinal toxicity of others cancer treatments and intestinal metastasis are the main differential diagnoses. Clinical characteristics of ICI enterocolitis resemble inflammatory bowel disease (IBD) flare-up, less frequently microscopic colitis. In mild forms of ICI enterocolitis, symptomatic management will be sufficient and ICI therapy can be continued. Moderate to severe form of ICI enterocolitis require ICI withdrawal, oral or intravenous corticotherapy, and, in about half cases, biologics. Resuming ICI therapy after complete remission of symptoms should be discussed on a case-by-case basis between oncologists and gastroenterologists. The risk of flare-up or ICI enterocolitis is about 40 % in IBD patients receiving ICI. Recent data suggests that biologics could reduce overall survival in patients suffering melanoma treated by ICI. [ABSTRACT FROM AUTHOR]