Immune checkpoint inhibitor-related colitis assessment and prognosis: can IBD scoring point the way?

Aged Carcinoma, Non-Small-Cell Lung / complications Colitis / chemically induced Colonoscopy Drug-Related Side Effects and Adverse Reactions Female Humans Immune Checkpoint Inhibitors / administration & dosage Infliximab / administration & dosage Male Melanoma / complications Middle Aged Prognosis Severity of Illness Index Treatment Outcome Urothelium / drug effects

Journal

British journal of cancer

ISSN: 1532-1827

Titre abrégé: Br J Cancer

Pays: England

ID NLM: 0370635

Informations de publication

Date de publication:
07 2020

Historique:

received: 19 12 2019

accepted: 24 04 2020

revised: 06 04 2020

pubmed: 19 5 2020

medline: 20 2 2021

entrez: 19 5 2020

Statut: ppublish

Résumé

Immune checkpoint inhibitors (ICI) improve survival but cause immune-related adverse events (irAE). We sought to determine if CTCAE classification, IBD biomarkers/endoscopic/histological scores correlate with irAE colitis outcomes. A dual-centre retrospective study was performed on patients receiving ICI for melanoma, NSCLC or urothelial cancer from 2012 to 2018. Demographics, clinical data, endoscopies (reanalysed using Mayo/Ulcerative Colitis Endoscopic Index of Severity (UCEIS) scores), histology (scored with Nancy Index) and treatment outcomes were analysed. In all, 1074 patients were analysed. Twelve percent (134) developed irAE colitis. Median patient age was 66, 59% were male. CTCAE diarrhoea grade does not correlate with steroid/ infliximab use. G3/4 colitis patients are more likely to need infliximab (p < 0.0001) but colitis grade does not correlate with steroid duration. CRP, albumin and haemoglobin do not correlate with severity. The UCEIS (p = 0.008) and Mayo (p = 0.016) scores correlate with severity/infliximab requirement. Patients with higher Nancy indices (3/4) are more likely to require infliximab (p = 0.03). CTCAE assessment does not accurately reflect colitis severity and our data do not support its use in isolation, as this may negatively impact timely management. Our data support utilising endoscopic scoring for patients with >grade 1 CTCAE disease, and demonstrate the potential prognostic utility of objective histologic scoring.

Sections du résumé

BACKGROUND

METHODS

A dual-centre retrospective study was performed on patients receiving ICI for melanoma, NSCLC or urothelial cancer from 2012 to 2018. Demographics, clinical data, endoscopies (reanalysed using Mayo/Ulcerative Colitis Endoscopic Index of Severity (UCEIS) scores), histology (scored with Nancy Index) and treatment outcomes were analysed.

RESULTS

In all, 1074 patients were analysed. Twelve percent (134) developed irAE colitis. Median patient age was 66, 59% were male. CTCAE diarrhoea grade does not correlate with steroid/ infliximab use. G3/4 colitis patients are more likely to need infliximab (p < 0.0001) but colitis grade does not correlate with steroid duration. CRP, albumin and haemoglobin do not correlate with severity. The UCEIS (p = 0.008) and Mayo (p = 0.016) scores correlate with severity/infliximab requirement. Patients with higher Nancy indices (3/4) are more likely to require infliximab (p = 0.03).

CONCLUSIONS

CTCAE assessment does not accurately reflect colitis severity and our data do not support its use in isolation, as this may negatively impact timely management. Our data support utilising endoscopic scoring for patients with >grade 1 CTCAE disease, and demonstrate the potential prognostic utility of objective histologic scoring.

Identifiants

DOI: 10.1038/s41416-020-0882-y PMID: 32418993 PMC: PMC7374736

pubmed: 32418993

doi: 10.1038/s41416-020-0882-y

pii: 10.1038/s41416-020-0882-y

pmc: PMC7374736

doi:

Substances chimiques

Immune Checkpoint Inhibitors 0

Infliximab B72HH48FLU

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

Pagination

207-215