Professor Coulie explains at a cellular level, T cell tolerance; thymic selection fine tunes the T-cell repertoire. He discusses antigenic stimulation and the mechanism by which a naïve T cell is first activated and becomes an antigen-experienced T cell via antibodies blocking the immune checkpoints, CTLA-4 and PD-1. Professor Coulie provides an overview of the current anti-CTLA-4 and anti-PD-1/PD-L1 therapies and summarizes how management of patients with oncological malignancies has advanced through scientific breakthroughs over the years. He discusses the immunologic etiology of immune-related adverse events (irAEs) and explains the link to the pathway for naïve T cells to become primed and persist to memory T cells. Professor Coulie ends his talk by discussing gastrointestinal (GI) toxicity after CTLA-4 or PD-1 blockade and the potential mechanisms underlying checkpoint inhibitor (CPI)–related GI irAEs.
In his presentation, Prof Van Cutsem conducts a journey through digestive oncology and immunotherapy in digestive cancers: colorectal, gastric, and esophageal cancer. He reviews the colorectal cancer subtypes, the particularities that characterize the chromosomal and microsatellite instability and the available evidence of the checkpoint inhibitors in the treatment of this tumor. He addresses the molecular characterization in gastric cancer, the treatment algorithms on gastric and esophageal cancer, and the main studies with positive data that raise a practice changing in unmet need populations with upper digestive tumors. In addition, Prof Van Cutsem shows the data treatment algorithm of the hepatocellular carcinoma, and the main data of the use of checkpoint inhibitors for the treatment of this disease. In parallel, Prof Pauwels highlights the predictive and prognostic importance of biomarkers for a better understanding and evolved treatment of digestive tumors.
The use of Immune Checkpoint Inhibitors (ICIs) may be associated with the development of a particular class of adverse events caused by an unregulated immune reaction and collectively named “immune-related adverse events” (irAEs). These irAEs can affect a wide range of organs, have varying degrees of severity and range widely in the timing of onset. Gastrointestinal presentations of irAEs typically include diarrhea and colitis. High clinical suspicion, timely evaluation and multi-disciplinary management provide the foundation for optimal clinical outcomes. In his, presentation Prof Van Cutsem focuses on the pathogenesis and the diagnostic approach of ICIs-induced GI disease, including the characteristic of endoscopic evaluation and histological findings associated with these irAEs. In the last part of the presentation the speaker examines the available Guidelines, based on grading and severity and sequential algorithms, and the important factors for the management of ICIs-induced GI disease, including the management of steroid-refractory GI-irAEs.
Understanding the details of the hepatic irAE is important for optimizing patient management. Although this irAE is not common, its management may be challenging, and it is managed best through a multidisciplinary team including experts in hepatology and liver pathology. Prof Van Steenkiste and Prof Pauwels, start their presentation with the discussion of a melanoma patient case referred to the Hepatology Department for grade IV hepatitis on ICI therapy, evaluate the clinical and histopathological features of the hepatic irAE and treatment strategy. The speakers discuss on how a liver biopsy can confirm a suspected diagnosis of immune-mediated hepatitis, can be used to evaluate the features and severity of liver tissue damage, and provide crucial elements that will drive the therapeutic decision. The second part of the presentation focuses on the management of hepatic irAE and, as spontaneous improvements in ICI-related liver toxicity have been reported, corticosteroid therapy should probably be individualized and tailored according to the severity of both the biology and histology of liver injury. The debate on the reintroduction of immunotherapy following a previous immune-mediated hepatitis and the management of patients with corticosteroid-resistant liver toxicity are the last topics discussed.