Nivolumab-Induced Fulminant Immune-Related Colitis Despite Infliximab in a Patient With NSCLC

Callens, Rutger; Tamsin, An; Zandweghe, Luc Van

doi:10.1016/j.jtho.2018.11.014

Cited by 5 publications

(7 citation statements)

References 5 publications

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“…Another case reported of a metastatic melanoma, treated with the same combination therapy, also developed corticosteroids refractory colitis that only improved after infliximab treatment [35]. One case of an infliximab refractory colitis was also described in a patient treated with nivolumab; in follow up, the patient developed bowel perforation that required total colectomy with terminal ileostomy; the patient eventually died from sepsis 35 days after the colectomy was performed [36]. When speaking about ICI induced colitis, although the usual histologic and endoscopic findings resemble that of the IBD, there are also reports of some unusual cases such as collagenous colitis after pembrolizumab and atezolizumab therapy [37,38].…”

Section: Discussionmentioning

confidence: 99%

“…Our search led us to various cases of severe refractory enterocolitis that responded only to infliximab therapy [34,35] and a case of infliximab refractory colitis. While cases of severe colitis associated with anti CTLA-3 therapy are rather frequent, severe cases after anti PD-1 therapy are scarcely reported, with an incidence of only 0.4 % [36]. Some unusual cases of colitis were also described, such as collagenous [37,38], pseudomembranous [39], granulomatous [40], microscopic colitis [41] or even inflammatory bowel diseases (IBD) [42][43][44] due to different types of ICI.…”

Section: Gastrointestinal Tract Toxicitymentioning

confidence: 99%

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Digestive Toxicities Secondary to Immune Checkpoint Inhibition Therapy – Reports of Rare Events. A Systematic Review

Radulescu

Crişan

Grapa

et al. 2021

JGLD

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Background and Aims: While immune checkpoint inhibitors therapy (ICI) is exceedingly effective, these drugs are associated with various immune-related adverse effects. As gastrointestinal, hepatic or pancreatic toxicity becomes more common, various reports of rare adverse effects have emerged, leading to a significant clinical and prognostic impact. We aimed to provide a systematic review of mainly case-reports on rare events, to help physicians to make an accurate and fast diagnosis. Methods: We performed a systematic review of the literature, using established MeSH terms: “immune checkpoint inhibitors”, “gastrointestinal tract”, “gastrointestinal diseases”, “liver”, “pancreas”, “nivolumab”, “ipilimumab”, the subheadings “adverse effects”, “toxicity” and the supplementary concepts “pembrolizumab”, “tremelimumab”, “atezolizumab”, “avelumab”, “durvalumab”, with defined inclusion criteria. Results: From 419 manuscripts initially selected, 74 reports of rare adverse events were included in our review. Special cases of neutrophilic gastritis, hemorrhagic gastritis, or even perforations were described at upper digestive tract. Different types of colitis were found secondary to ICI such as pseudomembranous, granulomatous, collagenous and microscopic colitis or even inflammatory bowel disease. In terms of liver toxicity, we found rare reports of cholangitis, granulomatous hepatitis, lipodystrophy and hepatic sinusoidal obstruction syndrome. Pancreas toxicity was rarely reported as severe pancreatitis, exocrine failure and diabetes mellitus. Conclusion: Although a complete check-up of every organ at every routine visit may not be practical, focus on symptoms, targeted laboratory and imaging testing may reveal rare organ damage. Raising awareness of the uncommon toxicities related to the immunotherapy is essential, as some rare events can lead to fatal outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Gastrointestinal Tract Toxicitymentioning

confidence: 99%

Digestive Toxicities Secondary to Immune Checkpoint Inhibition Therapy – Reports of Rare Events. A Systematic Review

Radulescu

Crişan

Grapa

et al. 2021

JGLD

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“…Table 3 summarizes the previous reports on the use of IFX for treating CS-resistant irAE colitis [ 56 , 60 , 81 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 ]. For CS-resistance irAE colitis, IFX 5 mg/kg/dose is administered intravenously according to the usual method of administration for IBD.…”

Section: Treatment Of Irae Colitismentioning

confidence: 99%

“…The duration of treatment with IFX is not clearly defined. Treatment response to IFX for irAE colitis generally occurs within a few days and symptoms resolve with one dose [ 56 , 87 , 87 , 88 ]. However, some patients with irAE colitis require a second dose of IFX two weeks later.…”

Section: Treatment Of Irae Colitismentioning

confidence: 99%

Pharmacological Treatments Available for Immune-Checkpoint-Inhibitor-Induced Colitis

et al. 2022

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Immune checkpoint inhibitor treatment has shown revolutionary therapeutic effects in various carcinomas. However, immune-related adverse events (irAE) following this treatment can sometimes lead to treatment discontinuation. One such frequently encountered adverse event is immune-related colitis (irAE colitis). Corticosteroids (CS) are the first-line treatment for irAE colitis, but we often encounter CS-refractory or -resistant cases. The application of multiple biologics has been proposed as a therapy to be administered after CS treatment; however, the efficacy and safety of biologics for patients with irAE colitis who do not respond to CS have not been established. This review summarizes the treatment regimens available for irAE colitis, focusing on the mechanism of action of corticosteroids, infliximab, vedolizumab, and other drugs.

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“…We also included two NSCLC cases with colonic perforation after receiving ICI therapy (50). One recovered after surgery and rechallenge ICIs with ongoing partial regression (50), while the other ultimately succumbed to infectious complications (55). The predictive risk factors for colon perforation are limited.…”

Section: Surgerymentioning

confidence: 99%

Immune Checkpoint Inhibitor-Associated Colitis: From Mechanism to Management

et al. 2021

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Immune checkpoint inhibitors (ICIs), as one of the innovative types of immunotherapies, including programmed cell death-1 (PD-1), programmed cell death-ligand 1 (PD-L1), and cytotoxic T lymphocyte antigen 4 (CTLA-4) inhibitors, have obtained unprecedented benefit in multiple malignancies. However, the immune response activation in the body organs could arise immune-related adverse events (irAEs). Checkpoint inhibitor colitis (CIC) is the most widely reported irAEs. However, some obscure problems, such as the mechanism concerning gut microbiota, the confusing differential diagnosis with inflammatory bowel disease (IBD), the optimal steroid schedule, the reintroduction of ICIs, and the controversial prognosis features, influence the deep understanding and precise diagnosis and management of CIC. Herein, we based on these problems and comprehensively summarized the relevant studies of CIC in patients with NSCLC, further discussing the future research direction of this specific pattern of irAEs.

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Nivolumab-Induced Fulminant Immune-Related Colitis Despite Infliximab in a Patient With NSCLC

Cited by 5 publications

References 5 publications

Digestive Toxicities Secondary to Immune Checkpoint Inhibition Therapy – Reports of Rare Events. A Systematic Review

Digestive Toxicities Secondary to Immune Checkpoint Inhibition Therapy – Reports of Rare Events. A Systematic Review

Pharmacological Treatments Available for Immune-Checkpoint-Inhibitor-Induced Colitis

Immune Checkpoint Inhibitor-Associated Colitis: From Mechanism to Management

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