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Gastroparesis Following Immune Checkpoint Inhibitor Therapy: A Case Series

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A Publisher Correction to this article was published on 07 August 2020

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Abstract

Background

Immune checkpoint inhibitors (ICI) have improved outcomes in patients with various malignancies; however, they can cause immune-related hepatitis and enterocolitis. Patients on ICI may also develop upper gastrointestinal symptoms and undergo measurement of gastric emptying.

Aims

Our aim was to review records of patients with gastroparesis following ICI therapy at two medical centers.

Methods

We performed a retrospective review of all patients at Mayo Clinic and Brigham and Women’s/Dana-Farber Cancer Center (BWH/DFCC) who underwent gastric scintigraphy for the assessment of symptoms of gastroparesis following ICI treatment up to January 2020. Clinical presentation, medical history, laboratory evaluation, imaging, treatment, and outcomes were retrieved from the records. Gastroparesis was diagnosed as delayed gastric emptying (GE) measured by gastric scintigraphy.

Results

At Mayo Clinic, 2 patients (median age 59 years, 1 male [M], 1 female [F]) had delayed GE, while 4 patients (median age 53 years, 3M, 1F) had normal GE following ICI use. Of those with delayed GE (diagnosed after 38 and 2 months of ICI initiation), 1 patient was treated for non-Hodgkin’s lymphoma and melanoma with ipilimumab; a second patient with breast cancer was treated with pembrolizumab. At BWH/DFCC, 2 patients (median age 56 years, 1M, 1F) had normal GE after ICI treatment, while a 62-year-old female with non-small cell lung cancer developed gastroparesis 3 months following initiation of nivolumab.

Conclusion

This report documents gastroparesis as a potential adverse effect of ICI. Further studies should explore the potential for ICI therapy to damage anti-inflammatory macrophages that preserve the enteric neurons.

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Funding

Michael Camilleri’s research work in gastroparesis is supported by Grant R01-DK122280 from National Institutes of Health. This study was also funded in part by NIH Grant T32-DK00753335 to Jordan Sack.

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Authors and Affiliations

  1. Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER) and Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. S.W., Rochester, MN, USA

    Jessica Atieh & Michael Camilleri

  2. Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women’s Hospital, Boston, MA, USA

    Jordan Sack & Shilpa Grover

  3. Harvard Medical School, Boston, MA, USA

    Jordan Sack, Richard Thomas, Osama E. Rahma & Shilpa Grover

  4. Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA

    Richard Thomas

  5. Department of Medical Oncology, Dana-Farber Cancer Institute, Brookline, MA, USA

    Osama E. Rahma

Authors
  1. Jessica Atieh
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  2. Jordan Sack
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  3. Richard Thomas
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  4. Osama E. Rahma
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  5. Michael Camilleri
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Contributions

JA contributed to acquisition of data, analysis and interpretation of data, drafting the manuscript, and approval of the final version of the manuscript. JS performed acquisition of data, analysis and interpretation of data, drafting the manuscript, and approval of the final version of the manuscript. RT helped in analysis and interpretation of data, critical revision of the manuscript, and approval of the final version of the manuscript. OER contributed to study concept, analysis and interpretation of data, critical revision of the manuscript, and approval of the final version of the manuscript. SG was involved in study concept, analysis and interpretation of data design, critical revision of the manuscript, study supervision, and approval of the final version of the manuscript. MC contributed to study design, analysis and interpretation of data, critical revision of the manuscript, study supervision, and approval of the final version of the manuscript.

Corresponding author

Correspondence to Michael Camilleri.

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Conflict of interest

Michael Camilleri has received research support for proof of concept single-center studies in gastroparesis from Bird Rock Bio and Takeda. Shilpa Grover is a Senior Gastroenterology Physician Editor at UpToDate, Inc. Jessica Atieh, Jordan Sack, Richard Thomas, and Osama E. Rahma have no conflicts of interest or financial ties to disclose.

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The original version of this article was revised: Table 2 was updated. The term 'Intestinal pseudo-obstruction' was inadvertently removed in the final version. The term was reinserted back in the Table 2.

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Atieh, J., Sack, J., Thomas, R. et al. Gastroparesis Following Immune Checkpoint Inhibitor Therapy: A Case Series. Dig Dis Sci 66, 1974–1980 (2021). https://doi.org/10.1007/s10620-020-06440-x

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  • DOI: https://doi.org/10.1007/s10620-020-06440-x

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