Characteristics and outcomes of cancer patients with pre-existing microscopic colitis after exposure to PD-1 and PD-L1 inhibitors

Thomas, Austin R.; Liu, Cynthia; Tong, Yi Tat; Tan, Dongfeng; Altan, Mehmet; Siddiqui, Bilal A.; Shatila, Malek; Khan, Anam; Thomas, Anusha Shirwaikar; Wang, Yinghong

doi:10.1007/s00432-022-04499-9

Cited by 3 publications

(3 citation statements)

References 37 publications

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“…The exacerbation of preexisting collagenous colitis after nivolumab exposure is another conceivable cause of diarrhea in the current patient. Thomas et al retrospectively investigated 10 patients with microscopic colitis (six with collagenous colitis and four with lymphocytic colitis) who received PD-1 or programmed cell death ligand 1 inhibitors [ 21 ]. The authors reported that eight patients experienced exacerbations of colitis after immune checkpoint inhibitor therapy, which necessitated immunosuppressive treatment.…”

Section: Discussionmentioning

confidence: 99%

Collagenous Colitis in a Patient With Gastric Cancer Who Underwent Chemotherapy

Iwamuro¹,

Tanaka²,

Kagawa³

et al. 2023

Cureus

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Herein, we present a case of collagenous colitis in a patient who underwent chemotherapy for gastric cancer, comprising five cycles of S-1 plus oxaliplatin and trastuzumab, followed by five cycles of paclitaxel and ramucirumab and seven cycles of nivolumab. The subsequent initiation of trastuzumab deruxtecan chemotherapy led to the development of grade 3 diarrhea after the second cycle of treatment. Collagenous colitis was diagnosed via colonoscopy and biopsy. The patient’s diarrhea improved following the cessation of lansoprazole. This case highlights the importance of considering collagenous colitis as a differential diagnosis, in addition to chemotherapy-induced colitis and immune-related adverse event (irAE) colitis, in patients with similar clinical presentations.

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Section: Discussionmentioning

confidence: 99%

Collagenous Colitis in a Patient With Gastric Cancer Who Underwent Chemotherapy

Iwamuro¹,

Tanaka²,

Kagawa³

et al. 2023

Cureus

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“…14,15 While the presence of preexisting IBD or microscopic colitis is not absolute contraindication to ICI therapy, patient evaluation should include an assessment of disease activity with risk-benefit analysis prior to immunotherapy initiation and close monitoring while on immunotherapy (expert opinion). [14][15][16][17][18][19] ICI colitis presents as loose stools with increased frequency over baseline (diarrhoea), with or without abdominal tenderness on physical examination; more severe cases may also include cramping abdominal pain, urgency, tenderness to abdominal palpation and hematochezia, though the absence of these additional signs/symptoms does not exclude the diagnosis. 20 Fever is also possible though may raise concern for a complication or non-ICI aetiology (e.g.…”

Section: Epidemiology and Classificationmentioning

confidence: 99%

“…Preexisting inflammatory bowel disease (IBD) and microscopic colitis also appear to confer an increased risk of exacerbation and ICI colitis 14,15 . While the presence of preexisting IBD or microscopic colitis is not absolute contraindication to ICI therapy, patient evaluation should include an assessment of disease activity with risk–benefit analysis prior to immunotherapy initiation and close monitoring while on immunotherapy (expert opinion) 14–19 …”

Section: Diarrhoea Colitis and Enteritismentioning

confidence: 99%

Review article: Contemporary management of gastrointestinal, pancreatic and hepatic toxicities of immune checkpoint inhibitors

Townsend,

Benque,

et al. 2024

Aliment Pharmacol Ther

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SummaryBackgroundImmune checkpoint inhibitors (ICIs) are effective oncologic agents which frequently cause immune‐related adverse events (irAEs) which can impact multiple organ systems. Onco‐Gastroenterology is a novel and emerging subspecialty within gastroenterology focused on cancer treatment‐related complications. Gastroenterologists must be prepared to identify and manage diverse immune‐mediated toxicities including enterocolitis, hepatitis, pancreatitis and other ICI‐induced toxicities.AimTo provide a narrative review of the epidemiology, diagnostic evaluation and management of checkpoint inhibitor‐induced gastrointestinal and hepatic toxicities.MethodsWe searched Cochrane and PubMed databases for articles published through August 2023.ResultsGastrointestinal and hepatic irAEs include most commonly enterocolitis and hepatitis, but also pancreatitis, oesophagitis, gastritis, motility disorders (gastroparesis) and other rarer toxicities. Guidelines from the National Comprehensive Cancer Network, American Society of Clinical Oncology and European Society for Medical Oncology, in combination with emerging cohort and clinical trial data, offer strategies for management of ICI toxicities. Evaluation of irAEs severity by formal classification and clinical stability, and a thorough workup for alternative etiologies which may clinically mimic irAEs underlie initial management. Treatments include corticosteroids, biologics and other immunosuppressive agents plus supportive care; decisions on dosing, timing and choice of steroid adjuncts and potential for subsequent checkpoint inhibitor dosing are nuanced and toxicity‐specific.ConclusionsExpanding clinical trial and cohort data have clarified the epidemiology and clinical characteristics of gastrointestinal, pancreatic and hepatic toxicities of ICIs. Guidelines, though valuable, remain based principally on retrospective cohort data. Quality prospective, controlled studies may refine algorithms for treatment and potential immunotherapy rechallenge.

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Vedolizumab

2023

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Characteristics and outcomes of cancer patients with pre-existing microscopic colitis after exposure to PD-1 and PD-L1 inhibitors

Cited by 3 publications

References 37 publications

Collagenous Colitis in a Patient With Gastric Cancer Who Underwent Chemotherapy

Collagenous Colitis in a Patient With Gastric Cancer Who Underwent Chemotherapy

Review article: Contemporary management of gastrointestinal, pancreatic and hepatic toxicities of immune checkpoint inhibitors

Vedolizumab

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