Outcomes of vedolizumab therapy in patients with immune checkpoint inhibitor-induced colitis: a multi-center study.
Outcomes of vedolizumab therapy in patients with immune checkpoint inhibitor-induced colitis: a multi-center study.
- 2018
BACKGROUND: Immune-mediated diarrhea and colitis (IMDC) can limit immune checkpoint inhibitors (ICIs) treatment, which is efficacious for advanced malignancies. Steroids and infliximab are commonly used to treat it. These agents induce systemic immunosuppression, with its associated morbidity. We assessed clinical outcomes of vedolizumab as an alternative treatment for IMDC. CONCLUSIONS: Vedolizumab can be appropriate for the treatment of steroid-refractory IMDC, with favorable outcomes and a good safety profile. METHODS: We analyzed a retrospective case series of adults who had IMDC refractory to steroids and/or infliximab and received vedolizumab from 12/2016 through 04/2018. RESULTS: Twenty-eight patients were included. The median time from ICI therapy to IMDC onset was 10 weeks. Fifteen patients (54%) had grade 2 and 13 (46%) had grade 3 or 4 IMDC. Mucosal ulceration was present in 8 patients (29%), and nonulcerative inflammation was present in 13 (46%). All patients had features of active histologic inflammation; 14 (50%) had features of chronicity, and 10 (36%) had features of microscopic colitis concurrently. The mean duration of steroid therapy was 96 days (standard deviation 74 days). Nine patients received infliximab in addition to steroids and their IMDC was refractory to it. Among these, the duration of steroid use was 131 days compared with 85 days in patients who did not receive infliximab. Likewise, patients who failed infliximab before vedolizumab had a clinical success rate of 67% compared to 95% for patients that did not receive infliximab. The median number of vedolizumab infusions was 3 (interquartile range 1-4). The mean duration of follow-up was 15 months. Twenty-four patients (86%) achieved and sustained clinical remission. Repeat endoscopic evaluation was performed in 17 patients. Endoscopic remission was attained in 7 (54%) of the 13 patients who had abnormal endoscopic findings initially; 5/17 patients (29%) reached histologic remission as well.
English
2051-1426
10.1186/s40425-018-0461-4 [doi] 10.1186/s40425-018-0461-4 [pii] PMC6280383 [pmc]
*Antibodies, Monoclonal, Humanized/tu [Therapeutic Use]
*Antineoplastic Agents, Immunological/ae [Adverse Effects]
*Colitis/dt [Drug Therapy]
*Colitis/et [Etiology]
*Gastrointestinal Agents/tu [Therapeutic Use]
*Neoplasms/co [Complications]
Aged
Antineoplastic Agents, Immunological/tu [Therapeutic Use]
Biomarkers
Biopsy
Colitis/di [Diagnosis]
Colonoscopy
Drug Resistance, Neoplasm
Female
Humans
Male
Middle Aged
Neoplasms/di [Diagnosis]
Neoplasms/dt [Drug Therapy]
Neoplasms/im [Immunology]
Retrospective Studies
Treatment Outcome
MedStar Washington Hospital Center
Gastroenterology/Hepatology
Journal Article
BACKGROUND: Immune-mediated diarrhea and colitis (IMDC) can limit immune checkpoint inhibitors (ICIs) treatment, which is efficacious for advanced malignancies. Steroids and infliximab are commonly used to treat it. These agents induce systemic immunosuppression, with its associated morbidity. We assessed clinical outcomes of vedolizumab as an alternative treatment for IMDC. CONCLUSIONS: Vedolizumab can be appropriate for the treatment of steroid-refractory IMDC, with favorable outcomes and a good safety profile. METHODS: We analyzed a retrospective case series of adults who had IMDC refractory to steroids and/or infliximab and received vedolizumab from 12/2016 through 04/2018. RESULTS: Twenty-eight patients were included. The median time from ICI therapy to IMDC onset was 10 weeks. Fifteen patients (54%) had grade 2 and 13 (46%) had grade 3 or 4 IMDC. Mucosal ulceration was present in 8 patients (29%), and nonulcerative inflammation was present in 13 (46%). All patients had features of active histologic inflammation; 14 (50%) had features of chronicity, and 10 (36%) had features of microscopic colitis concurrently. The mean duration of steroid therapy was 96 days (standard deviation 74 days). Nine patients received infliximab in addition to steroids and their IMDC was refractory to it. Among these, the duration of steroid use was 131 days compared with 85 days in patients who did not receive infliximab. Likewise, patients who failed infliximab before vedolizumab had a clinical success rate of 67% compared to 95% for patients that did not receive infliximab. The median number of vedolizumab infusions was 3 (interquartile range 1-4). The mean duration of follow-up was 15 months. Twenty-four patients (86%) achieved and sustained clinical remission. Repeat endoscopic evaluation was performed in 17 patients. Endoscopic remission was attained in 7 (54%) of the 13 patients who had abnormal endoscopic findings initially; 5/17 patients (29%) reached histologic remission as well.
English
2051-1426
10.1186/s40425-018-0461-4 [doi] 10.1186/s40425-018-0461-4 [pii] PMC6280383 [pmc]
*Antibodies, Monoclonal, Humanized/tu [Therapeutic Use]
*Antineoplastic Agents, Immunological/ae [Adverse Effects]
*Colitis/dt [Drug Therapy]
*Colitis/et [Etiology]
*Gastrointestinal Agents/tu [Therapeutic Use]
*Neoplasms/co [Complications]
Aged
Antineoplastic Agents, Immunological/tu [Therapeutic Use]
Biomarkers
Biopsy
Colitis/di [Diagnosis]
Colonoscopy
Drug Resistance, Neoplasm
Female
Humans
Male
Middle Aged
Neoplasms/di [Diagnosis]
Neoplasms/dt [Drug Therapy]
Neoplasms/im [Immunology]
Retrospective Studies
Treatment Outcome
MedStar Washington Hospital Center
Gastroenterology/Hepatology
Journal Article