A 1-year follow-up study on checkpoint inhibitor-induced colitis: results from a European consortium.

colitis immunotherapy infliximab nivolumab pembrolizumab

Journal

ESMO open
ISSN: 2059-7029
Titre abrégé: ESMO Open
Pays: England
ID NLM: 101690685

Informations de publication

Date de publication:
05 Jul 2024
Historique:
received: 13 04 2024
revised: 22 05 2024
accepted: 10 06 2024
medline: 6 7 2024
pubmed: 6 7 2024
entrez: 6 7 2024
Statut: aheadofprint

Résumé

Data regarding the clinical outcome of patients with immune checkpoint inhibitor (ICI)-induced colitis are scant. We aimed to describe the 12-month clinical outcome of patients with ICI-induced colitis. This was a retrospective, European, multicentre study. Endoscopy/histology-proven ICI-induced colitis patients were enrolled. The 12-month clinical remission rate, defined as a Common Terminology Criteria for Adverse Events diarrhoea grade of 0-1, and the correlates of 12-month remission were assessed. Ninety-six patients [male:female ratio 1.5:1; median age 65 years, interquartile range (IQR) 55.5-71.5 years] were included. Lung cancer (41, 42.7%) and melanoma (30, 31.2%) were the most common cancers. ICI-related gastrointestinal symptoms occurred at a median time of 4 months (IQR 2-7 months). An inflammatory bowel disease (IBD)-like pattern was present in 74 patients (77.1%) [35 (47.3%) ulcerative colitis (UC)-like, 11 (14.9%) Crohn's disease (CD)-like, 28 (37.8%) IBD-like unclassified], while microscopic colitis was present in 19 patients (19.8%). As a first line, systemic steroids were the most prescribed drugs (65, 67.7%). The 12-month clinical remission rate was 47.7 per 100 person-years [95% confidence interval (CI) 33.5-67.8). ICI was discontinued due to colitis in 66 patients (79.5%). A CD-like pattern was associated with remission failure (hazard ratio 3.84, 95% CI 1.16-12.69). Having histopathological signs of microscopic colitis (P = 0.049) and microscopic versus UC-/CD-like colitis (P = 0.014) were associated with a better outcome. Discontinuing the ICI was not related to the 12-month remission (P = 0.483). Four patients (3.1%) died from ICI-induced colitis. Patients with IBD-like colitis may need an early and more aggressive treatment. Future studies should focus on how to improve long-term clinical outcomes.

Sections du résumé

BACKGROUND BACKGROUND
Data regarding the clinical outcome of patients with immune checkpoint inhibitor (ICI)-induced colitis are scant. We aimed to describe the 12-month clinical outcome of patients with ICI-induced colitis.
MATERIALS AND METHODS METHODS
This was a retrospective, European, multicentre study. Endoscopy/histology-proven ICI-induced colitis patients were enrolled. The 12-month clinical remission rate, defined as a Common Terminology Criteria for Adverse Events diarrhoea grade of 0-1, and the correlates of 12-month remission were assessed.
RESULTS RESULTS
Ninety-six patients [male:female ratio 1.5:1; median age 65 years, interquartile range (IQR) 55.5-71.5 years] were included. Lung cancer (41, 42.7%) and melanoma (30, 31.2%) were the most common cancers. ICI-related gastrointestinal symptoms occurred at a median time of 4 months (IQR 2-7 months). An inflammatory bowel disease (IBD)-like pattern was present in 74 patients (77.1%) [35 (47.3%) ulcerative colitis (UC)-like, 11 (14.9%) Crohn's disease (CD)-like, 28 (37.8%) IBD-like unclassified], while microscopic colitis was present in 19 patients (19.8%). As a first line, systemic steroids were the most prescribed drugs (65, 67.7%). The 12-month clinical remission rate was 47.7 per 100 person-years [95% confidence interval (CI) 33.5-67.8). ICI was discontinued due to colitis in 66 patients (79.5%). A CD-like pattern was associated with remission failure (hazard ratio 3.84, 95% CI 1.16-12.69). Having histopathological signs of microscopic colitis (P = 0.049) and microscopic versus UC-/CD-like colitis (P = 0.014) were associated with a better outcome. Discontinuing the ICI was not related to the 12-month remission (P = 0.483). Four patients (3.1%) died from ICI-induced colitis.
CONCLUSIONS CONCLUSIONS
Patients with IBD-like colitis may need an early and more aggressive treatment. Future studies should focus on how to improve long-term clinical outcomes.

Identifiants

DOI: 10.1016/j.esmoop.2024.103632 PMID: 38970840
pubmed: 38970840
pii: S2059-7029(24)01401-7
doi: 10.1016/j.esmoop.2024.103632
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

103632

Investigateurs

C Mengoli (C)
N Aronico (N)
F Lepore (F)
G Broglio (G)
S Merli (S)
G Natalello (G)
E Alimenti (E)
D Scalvini (D)
S Muscarella (S)
F Agustoni (F)
A Pagani (A)
S Chiellino (S)
S Corallo (S)
V Musella (V)
R Cannizzaro (R)
M Vecchi (M)
F Caprioli (F)
R Gabbiadini (R)
A Dal Buono (A)
A Premoli (A)
L D Locati (LD)
A Buda (A)
A Contaldo (A)
A Schiepatti (A)
F Biagi (F)
D Morano (D)
M Cucè (M)
A Kotsakis (A)
G De Lisi (G)

Informations de copyright

Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Auteurs

M V Lenti (MV)

Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

D G Ribaldone (DG)

Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy.

F Borrelli de Andreis (F)

Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Digestive Endoscopy Unit, Isola Tiberina - Gemelli Isola Hospital, Rome, Italy.

M Vernero (M)

Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy.

B Barberio (B)

Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.

M De Ruvo (M)

Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.

E V Savarino (EV)

Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.

T Kav (T)

Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye.

A Blesl (A)

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.

M Franzoi (M)

Department of Internal Medicine and Gastroenterology, Academic Teaching Hospital Brothers of St John of God, St Veit an der Glan, Austria.

H P Gröchenig (HP)

Department of Internal Medicine and Gastroenterology, Academic Teaching Hospital Brothers of St John of God, St Veit an der Glan, Austria.

D Pugliese (D)

Department of Medical and Surgical Sciences, CEMAD (Digestive Disease Center), Policlinico Universitario 'A. Gemelli' IRCCS Foundation, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore Roma, Rome, Italy; UOS Gastroenterologia, Ospedale Isola Tiberina Gemelli Isola, Rome, Italy.

G Ianiro (G)

Department of Medical and Surgical Sciences, CEMAD (Digestive Disease Center), Policlinico Universitario 'A. Gemelli' IRCCS Foundation, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore Roma, Rome, Italy.

S Porcari (S)

Department of Medical and Surgical Sciences, CEMAD (Digestive Disease Center), Policlinico Universitario 'A. Gemelli' IRCCS Foundation, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore Roma, Rome, Italy.

G Cammarota (G)

Department of Medical and Surgical Sciences, CEMAD (Digestive Disease Center), Policlinico Universitario 'A. Gemelli' IRCCS Foundation, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore Roma, Rome, Italy.

A Gasbarrini (A)

Department of Medical and Surgical Sciences, CEMAD (Digestive Disease Center), Policlinico Universitario 'A. Gemelli' IRCCS Foundation, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore Roma, Rome, Italy.

R Spagnuolo (R)

Department of Health Sciences, University 'Magna Graecia', Catanzaro, Italy.

P Ellul (P)

Division of Gastroenterology, Department of Medicine, Mater Dei Hospital, Msida, Malta.

K Foteinogiannopoulou (K)

Department of Gastroenterology, University Hospital of Heraklion, Heraklion, Crete, Greece.

I Koutroubakis (I)

Department of Gastroenterology, University Hospital of Heraklion, Heraklion, Crete, Greece.

K Argyriou (K)

Department of Gastroenterology, University Hospital of Larisa, Larisa, Greece.

M Cappello (M)

Gastroenterology & Hepatology Section, PROMISE, University of Palermo, Palermo, Italy.

A Jauregui-Amezaga (A)

Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium; Laboratory of Experimental Medicine and Pediatrics (LEMP), Division of Gastroenterology-Hepatology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.

M G Demarzo (MG)

Department of Internal Medicine, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Gastroenterology Unit, University of Genoa, Genoa, Italy.

N Silvestris (N)

Medical Oncology Unit, Department of Human Pathology of Adulthood and Childhood DETEV 'G. Barresi', University of Messina, Messina, Italy.

A Armuzzi (A)

IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.

F Sottotetti (F)

Istituti Clinici Scientifici Maugeri IRCCS, Medical Oncology Unit, Pavia, Italy.

L Bertani (L)

Department of General Surgery and Gastroenterology, Tuscany North West ASL, Pontedera Hospital, Pontedera, Italy.

S Festa (S)

IBD Unit, Ospedale S. Filippo Neri, Rome, Italy.

P Eder (P)

Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland.

P Pedrazzoli (P)

Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

A Lasagna (A)

Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

A Vanoli (A)

Unit of Anatomic Pathology, Department of Molecular Medicine, University of Pavia, and IRCCS San Matteo Hospital Foundation, Pavia, Italy.

G Gambini (G)

Clinical Epidemiology and Biometry Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

G Santacroce (G)

Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

C M Rossi (CM)

Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

M Delliponti (M)

First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

C Klersy (C)

Clinical Epidemiology and Biometry Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

G R Corazza (GR)

Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

A Di Sabatino (A)

Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. Electronic address: a.disabatino@smatteo.pv.it.

Classifications MeSH