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Checkpoint Inhibitor-Induced Colitis: A New Type of Inflammatory Bowel Disease?

Madeline Bertha1, Emanuelle Bellaguara1, Timothy Kuzel2

  • 1Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, IL.

ACG Case Reports Journal
|October 19, 2017
PubMed

Insights

Checkpoint inhibitors can cause colitis, an immune-related side effect. In a metastatic melanoma patient, this condition evolved into a Crohn's disease-like phenotype after receiving additional immunotherapy.

Area of Science:

  • Oncology
  • Immunology
  • Gastroenterology

Background:

  • Checkpoint inhibitors are immune-stimulatory antibodies revolutionizing cancer treatment, particularly for metastatic melanoma.
  • Immune-related adverse events (irAEs) are known complications of these therapies.
  • Checkpoint inhibitor-induced colitis shares features with inflammatory bowel diseases (IBD) like Crohn's disease and ulcerative colitis.

Observation:

  • A 73-year-old man with metastatic melanoma developed colitis after ipilimumab treatment.
  • The addition of pembrolizumab led to a transformation of the colitis.
  • The patient's condition exhibited characteristics resembling Crohn's colitis.

Findings:

  • Checkpoint inhibitor-induced colitis may represent a distinct phenotype within inflammatory bowel disease.
  • The sequential use of ipilimumab and pembrolizumab can induce a Crohn's-like colitis.
  • This case highlights the complex interplay between cancer immunotherapy and gastrointestinal immune responses.

Implications:

  • Understanding this new IBD phenotype is crucial for managing cancer patients receiving immunotherapy.
  • Further research is needed to elucidate the mechanisms driving this transformation.
  • This finding may inform the development of targeted management strategies for immunotherapy-induced gastrointestinal irAEs.

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