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

• Published in: Journal of cancer research and clinical oncology Vol. 149; no. 8; pp. 5429 - 5436
• Main Authors: Thomas, Austin R., Liu, Cynthia, Tong, Yi T., Tan, Dongfeng, Altan, Mehmet, Siddiqui, Bilal A., Shatila, Malek, Khan, Anam, Thomas, Anusha S., Wang, Yinghong
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.07.2023; Springer Nature B.V
• Subjects: Budesonide; Cancer; Cancer Research; Colitis; Diarrhea; Gastrointestinal tract; Hematology; Immune checkpoint inhibitors; Immunosuppression; Inflammatory bowel disease; Internal Medicine; Lung cancer; Medicine; Medicine & Public Health; Melanoma; Oncology; Patients; PD-1 protein; PD-L1 protein; Prophylaxis; Steroid hormones; Transplantation; Diarrhea; Immune checkpoint inhibitor; Microscopic colitis; Cancer
• ISSN: 0171-5216; 1432-1335
• DOI: 10.1007/s00432-022-04499-9

Purpose Immune checkpoint inhibitors (ICIs) are frequently associated with adverse events, often affecting the gastrointestinal tract. We conducted this study to determine the characteristics and outcomes of cancer patients with pre-existing microscopic colitis (MC) who underwent ICI treatment. Methods In this retrospective study, we identified 10 patients with pre-existing MC who received ICIs at our center 01/2010–06/2020. Clinical characteristics and disease outcomes were recorded. Results Of 124 screened patients with MC before ICI exposure, 10 had sufficient data to be included in the study. Melanoma (40%) and lung cancer (30%) were the most prevalent cancer types, with 70% of stage IV cancer. Patients received either anti-programmed death 1 regimen (8, 80%) or anti-programmed death ligand 1 agent (2, 20%). Six patients (60%) had collagenous colitis, and 4 (40%) had lymphocytic colitis. The median time from MC diagnosis to ICI initiation was 4 years, with 1 patient on budesonide within 2 months of ICI initiation. Eight patients (80%) developed colitis exacerbations after ICI  and required selective immunosuppression. One patient received a compassionate-use fecal transplantation. The median time from ICI to colitis exacerbation was 14 days, with 40% and 50% of patients experiencing grade 3 diarrhea and grade 2 colitis, respectively, leading to hospitalization in 3 patients. Six patients received steroids and vedolizumab with no colitis recurrence. Of 8 patients who had colitis exacerbation, 6 resumed ICI therapy afterward; with 5 receiving concomitant vedolizumab for secondary prophylaxis. Conclusion Our findings suggest that ICI exposure increases the risk of exacerbation of underlying colitis necessitating and responding to potent immunosuppression therapy.