A 1-year follow-up study on checkpoint inhibitor-induced colitis: results from a European consortium.
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Lenti M V, Ribaldone D G, Borrelli de Andreis F, Vernero M, Barberio B, De Ruvo M, Savarino E V, Kav T, Blesl A, Franzoi M, Gröchenig H P, Pugliese D, Ianiro G, Porcari S, Cammarota G, Gasbarrini A, Spagnuolo R, Ellul P, Foteinogiannopoulou K, Koutroubakis I, Argyriou K, Cappello M, Jauregui-Amezaga A, Demarzo M G, Silvestris N, Armuzzi A, Sottotetti F, Bertani L, Festa S, Eder P, Pedrazzoli P, Lasagna A, Vanoli A, Gambini G, Santacroce G, Rossi C M, Delliponti M, Klersy C, Corazza G R, Di Sabatino A, European Consortium for the study of immune checkpoint inhibitor-induced colitis
Аннотация
MATERIALS AND METHODS: This was a retrospective, European, multicentre study. Endoscopy/histology-proven ICI-induced colitis patients were enrolled. The 12-month clinical remission rate, defined as a Common Terminology Criteria for Adverse Events diarrhoea grade of 0-1, and the correlates of 12-month remission were assessed.
RESULTS: Ninety-six patients [male:female ratio 1.5:1; median age 65 years, interquartile range (IQR) 55.5-71.5 years] were included. Lung cancer (41, 42.7%) and melanoma (30, 31.2%) were the most common cancers. ICI-related gastrointestinal symptoms occurred at a median time of 4 months (IQR 2-7 months). An inflammatory bowel disease (IBD)-like pattern was present in 74 patients (77.1%) [35 (47.3%) ulcerative colitis (UC)-like, 11 (14.9%) Crohn's disease (CD)-like, 28 (37.8%) IBD-like unclassified], while microscopic colitis was present in 19 patients (19.8%). As a first line, systemic steroids were the most prescribed drugs (65, 67.7%). The 12-month clinical remission rate was 47.7 per 100 person-years [95% confidence interval (CI) 33.5-67.8). ICI was discontinued due to colitis in 66 patients (79.5%). A CD-like pattern was associated with remission failure (hazard ratio 3.84, 95% CI 1.16-12.69). Having histopathological signs of microscopic colitis (P = 0.049) and microscopic versus UC-/CD-like colitis (P = 0.014) were associated with a better outcome. Discontinuing the ICI was not related to the 12-month remission (P = 0.483). Four patients (3.1%) died from ICI-induced colitis.
CONCLUSIONS: Patients with IBD-like colitis may need an early and more aggressive treatment. Future studies should focus on how to improve long-term clinical outcomes.