Extracorporeal photopheresis for cancer immunotherapy-related gastrointestinal toxicity: emerging clinical evidence
Year: 2026
Type: editorial
Study design: Systematic Review
Abstract: Immune-mediated gastrointestinal toxicities of cancer immunotherapy can be severe, corticosteroid-refractory, and treatment-limiting. Extracorporeal photopheresis (ECP) may provide immunomodulation with less systemic immunosuppression. To evaluate the role of ECP in immune-mediated gastrointestinal toxicity, we searched MEDLINE, Embase and Scopus from inception through July 2026 for human studies in which ECP was used to treat gastrointestinal toxicity associated with immune-checkpoint inhibitors or immune-effector-cell therapies. Study characteristics, treatment regimens, clinical response, corticosteroid use, mucosal healing, recurrence, and safety were narratively synthesized. Among 1423 records, seven publications were identified: three case reports, two uncontrolled cohorts, one prospective non-randomized comparative study, and one CAR T-cell enterocolitis series containing a single ECP-treated patient. Across reports of immune-checkpoint-inhibitor-associated colitis, ECP was followed by clinical improvement, corticosteroid exposure reduction, and, where assessed, endoscopic or histological improvement. In the PRIA ECP study, complete resolution occurred in 11/12 ECP-treated colitis events and 13/16 colitis events treated with systemic immunosuppression (91% vs 81%; p=0.61). Across all organ toxicities, ECP was associated with lower cumulative corticosteroid exposure and fewer worsening events. No serious ECP-attributable adverse events were reported. ECP is a promising rescue or corticosteroid-sparing option for selected refractory gastrointestinal toxicities; however, efficacy remains unproven because evidence is limited, heterogeneous, and predominantly uncontrolled. Randomized controlled trials evaluating standardized clinical and endoscopic outcomes, corticosteroid-free remission, safety, and treatment burden are required.
Authors: Saikat Mandal, Manideepa Maji, Arkadeep Dhali
Institutions: Nottingham University Hospitals NHS Trust, University of Nottingham, NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham Biomedical Research Centre, University of Hull, Hull University Teaching Hospitals NHS Trust, Hull York Medical School, Queen's University Belfast, Sheffield Teaching Hospitals NHS Foundation Trust, Imperial College London
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,490
OpenAlex ID: W7223129899