Risk of bowel obstruction in patients with colon cancer responding to immunotherapy: an international case series.

bowel obstruction case series colon cancer immunotherapy regression

Journal

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

Informations de publication

Date de publication:
05 Sep 2024
Historique:
received: 29 06 2024
revised: 31 07 2024
accepted: 05 08 2024
medline: 7 9 2024
pubmed: 7 9 2024
entrez: 6 9 2024
Statut: aheadofprint

Résumé

Immunotherapy is used routinely for treating deficient mismatch repair (dMMR) colon cancer (CC). This case series highlights an emerging safety issue, where patients develop bowel obstruction associated with immunotherapy response. Patients with dMMR CC who developed bowel obstruction while responding to immunotherapy were retrospectively identified. Data on patient, disease, treatment, and response-specific factors were explored for potential risk factors. Overall treatment numbers were used to estimate incidence. Nine patients from eight European centres were included. Common features were hepatic flexure location (5/9), T4 radiological staging (6/9), annular shape (8/9), radiological stricturing (5/9), and endoscopic obstruction (6/9). All received pembrolizumab and obstructed between 45 and 652 days after starting treatment. Seven patients underwent surgical resection; one was managed with a defunctioning stoma; and one was managed conservatively. One patient died from obstruction. Radiological response was seen in eight patients, including two complete responses. Pathological response was seen in all seven who underwent resection, including four complete responses. The overall incidence of immunotherapy response-related obstruction in these centres was 1.51%. Bowel obstruction associated with immunotherapy response may represent a rare treatment-related complication in dMMR CC. Clinicians must recognise this safety signal and share experience to maintain patient safety.

Sections du résumé

BACKGROUND BACKGROUND
Immunotherapy is used routinely for treating deficient mismatch repair (dMMR) colon cancer (CC). This case series highlights an emerging safety issue, where patients develop bowel obstruction associated with immunotherapy response.
PATIENTS AND METHODS METHODS
Patients with dMMR CC who developed bowel obstruction while responding to immunotherapy were retrospectively identified. Data on patient, disease, treatment, and response-specific factors were explored for potential risk factors. Overall treatment numbers were used to estimate incidence.
RESULTS RESULTS
Nine patients from eight European centres were included. Common features were hepatic flexure location (5/9), T4 radiological staging (6/9), annular shape (8/9), radiological stricturing (5/9), and endoscopic obstruction (6/9). All received pembrolizumab and obstructed between 45 and 652 days after starting treatment. Seven patients underwent surgical resection; one was managed with a defunctioning stoma; and one was managed conservatively. One patient died from obstruction. Radiological response was seen in eight patients, including two complete responses. Pathological response was seen in all seven who underwent resection, including four complete responses. The overall incidence of immunotherapy response-related obstruction in these centres was 1.51%.
CONCLUSIONS CONCLUSIONS
Bowel obstruction associated with immunotherapy response may represent a rare treatment-related complication in dMMR CC. Clinicians must recognise this safety signal and share experience to maintain patient safety.

Identifiants

DOI: 10.1016/j.esmoop.2024.103698 PMID: 39241497
pubmed: 39241497
pii: S2059-7029(24)01467-4
doi: 10.1016/j.esmoop.2024.103698
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

103698

Informations de copyright

Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.

Auteurs

J R Platt (JR)

Division of Oncology, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds. Electronic address: j.r.platt@leeds.ac.uk.

J Allotey (J)

Department of Oncology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK.

E Alouani (E)

Digestive Oncology Department, Rangueil Hospital, University Hospital of Toulouse, Toulouse, France.

J Glasbey (J)

Institute of Applied Health Research, University of Birmingham, Birmingham, UK. Electronic address: https://twitter.com/DrJamesGlasbey.

R Intini (R)

Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua.

S Lonardi (S)

Medical Oncology 3, Veneto Institute of Oncology IOV-IRCCS, Padua.

G Mazzoli (G)

Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.

A M Militello (AM)

Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK.

D P Modest (DP)

Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin; German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany.

J Palle (J)

Université Paris Cité, Digestive Oncology Department, Hôpital Européen Georges Pompidou, Paris; Université Paris Cité, Pancreatology and Digestive Oncology Department, Hôpital Beaujon, Clichy, France.

F Pietrantonio (F)

Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.

K Riyad (K)

The John Goligher Colorectal Surgery Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK.

L Samuel (L)

Department of Oncology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK.

A V Schulze (AV)

Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin.

K K Shiu (KK)

Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK.

J Taieb (J)

Institut du Cancer Paris CARPEM, Gastroenterology and Digestive Oncology Department, APHP Centre - Université Paris Cité, Hôpital Européen Georges Pompidou, Paris, France.

D J M Tolan (DJM)

Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds.

N P West (NP)

Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.

A C Westwood (AC)

Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.

C J M Williams (CJM)

Division of Oncology, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds. Electronic address: https://twitter.com/chrisjmwilliams.

J F Seligmann (JF)

Division of Oncology, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds.

Classifications MeSH