Opportunistic bowel infection after corticosteroid dosage tapering in a stage IV lung cancer patient with tislelizumab‐related colitis

Ni, Jun; Zhang, Xiaolin; Zhang, Li

doi:10.1111/1759-7714.13401

Cited by 8 publications

(4 citation statements)

References 14 publications

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“…They found that most of the patients need steroid, while a minority of them required IFX or vedolizumab, regardless of whether in the initial or recurrent episode. Our analysis showed that 25% (8/32) of patients (36,41,43,46,48,54,57) had recurrent ICI-mediated colitis without ICI retreatment, which received subsequent therapy involving probiotics, antidiarrheal drugs, antiviral drugs, steroid, and immunosuppressants. Four cases with CIC finally did not improve or deteriorate after the second treatment (36,41,48,54).…”

Section: Rechallenge and Recurrencementioning

confidence: 87%

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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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Section: Rechallenge and Recurrencementioning

confidence: 87%

“…It is worthy to notice that CIC could develop with bowel infection at the same time. One of our cases developed CIC that coexisted with CMV and Salmonella (46). Therefore, in addition to etiology detection, endoscopic biopsy is essential for accurate diagnosis.…”

Section: Diagnosismentioning

confidence: 96%

Immune Checkpoint Inhibitor-Associated Colitis: From Mechanism to Management

et al. 2021

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“…The trAEs of tislelizumab application in lung cancer exhibited considerable diversity, with the most prevalent being blood system disorders, a pattern that aligns with our study findings. Other case reports include membranous nephropathy [ 25 ], colitis [ 26 ], enteritis [ 27 ] and multiple organ damage [ 28 ]. In contrast to pembrolizumab and nivolumab, it attaches to PD-1 at a distinct epitope, with a dissociation rate for PD-1 that is ∼100- and 50-fold slower, respectively [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of tislelizumab plus chemotherapy as preoperative treatment in potentially resectable locally advanced non-small-cell lung cancer patients

Huang,

Zhu,

Liu

et al. 2023

Interdisciplinary CardioVascular and Thoracic Surgery

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Objectives Locally advanced non-small cell lung cancer (LA-NSCLC) requires more preoperative regiments in the era of immunotherapy. Tislelizumab was approved for first-line treatment for advanced lung cancer, bringing hope for preoperative therapy in LA-NSCLC. The aim of this study was to investigate the safety and efficacy of preoperative tislelizumab plus chemotherapy in LA-NSCLC. Methods The medical records at the First Affiliated Hospital of Zhejiang University were examined retrospectively from September 2019 to June 2022 for this descriptive single-arm cohort study. Patients with LA-NSCLC were treated with tislelizumab plus platinum-based dual-drug regimens for 2-6 cycles and regular imaging assessments were performed every 1-2 cycles. Data including demographic characteristics, clinicopathological staging, adverse events, and surgery-related details were recorded in specifically designed forms. Results Forty patients met the inclusion criteria of the study and 23 patients underwent curative-intent surgeries. Significantly clinical and pathological downstaging was observed, with the objective response rate being 65.00%, leading to a major pathological remission (MPR) rate of 56.52% and a pathological complete remission (pCR) rate of 34.78%. Grade 3-4 treatment-related adverse events occurred in 4 patients and no perioperative death occurred. The 1-year progress-free survival (PFS) rate and the 1-year overall survival (OS) rate were 85.0% and 90.0% respectively. Conclusions Tislelizumab plus chemotherapy as preoperative therapy demonstrates promising antitumor activity for potentially resectable LA-NSCLC with high MPR, pCR, and acceptable toxicity and survival.

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“…Cancer patients with CDI have significantly higher mortality and longer hospital stays than those without CDI [ 11 ]. IMDC from ICI therapy can mirror the diarrheal symptoms of CDI, and treatment of IMDC has been shown to predispose patients to GI infections [ 12 ]. Limited data exist concerning the clinical course and outcomes of CDI in patients with IMDC.…”

Section: Discussionmentioning

confidence: 99%

Clostridioides difficile infection in cancer patients receiving immune checkpoint inhibitors

Vasavada

Panneerselvam

Amin

et al. 2022

aog

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Background Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment, but are associated with immune-mediated diarrhea and colitis (IMDC). Clostridioides difficile infection (CDI) can cause infectious diarrhea with overlapping symptoms. Thus, we sought to elucidate the characteristics of CDI in patients treated with ICI, in the context of IMDC. Methods We conducted a retrospective, single-center study of adult cancer patients (N=421) with ICI exposure from 2015-2020 and a positive stool nucleic acid amplification test and/or enzyme immunoassay for CDI. Baseline characteristics, treatments, and outcomes were compared between patients with and without concurrent IMDC. Results Forty-one eligible patients were included, 27 with concurrent IMDC and 14 without. Twenty-seven patients were taking programmed death-1 or its ligand inhibitors and 14 were taking cytotoxic T-lymphocyte-associated antigen 4 inhibitors. Patients with concurrent CDI and IMDC had a longer symptom duration (20 vs. 5 days, P=0.003) and a higher rate of grade 3-4 diarrhea (41% vs. 7%, P=0.033). Among patients with concurrent IMDC, preceding antibiotics (P=0.050) and proton pump inhibitors (PPI) (P=0.038) were used more frequently among individuals who developed CDI after immunosuppressant exposure. Thirty-eight patients received antibiotics for CDI, while 5 required fecal microbiota transplantation for concurrent CDI & IMDC. Conclusions CDI is common in ICI-treated cancer patients, especially those with IMDC requiring immunosuppressants. Antibiotics did not alter the need for immunosuppressants in those with concurrent IMDC. Use of PPI and antibiotics while receiving immunosuppressants for IMDC was associated with a greater risk of CDI. Further large-scale studies are warranted to clarify the role of CDI, antibiotics and immunosuppression treatment in IMDC patients.

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Opportunistic bowel infection after corticosteroid dosage tapering in a stage IV lung cancer patient with tislelizumab‐related colitis

Cited by 8 publications

References 14 publications

Immune Checkpoint Inhibitor-Associated Colitis: From Mechanism to Management

Immune Checkpoint Inhibitor-Associated Colitis: From Mechanism to Management

Safety and efficacy of tislelizumab plus chemotherapy as preoperative treatment in potentially resectable locally advanced non-small-cell lung cancer patients

Clostridioides difficile infection in cancer patients receiving immune checkpoint inhibitors

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