Immune checkpoint inhibitor-induced colitis: A comprehensive review

Area of Science:

• Oncology
• Immunology
• Gastroenterology

Background:

• Immune checkpoint inhibitors (ICIs) revolutionize cancer treatment by modulating the immune response.
• ICIs can lead to immune-related adverse events, including immune-mediated colitis (IMC).
• IMC incidence varies (1-25%) based on ICI type and combination therapy.

Purpose of the Study:

• To review the management of immune-mediated colitis (IMC) in patients receiving immune checkpoint inhibitors (ICIs).

Main Methods:

• Literature review of studies on ICI-induced colitis management.
• Analysis of treatment strategies including corticosteroids, infliximab, and vedolizumab.
• Discussion of diagnostic overlap between IMC and inflammatory bowel disease.

Main Results:

• Corticosteroids are recommended for grade 2+ IMC, often requiring immunotherapy cessation.
• Approximately one-third to two-thirds of patients are steroid-refractory, benefiting from infliximab.
• Vedolizumab shows efficacy in steroid- and infliximab-refractory IMC.

Conclusions:

• Management of ICI-induced colitis requires a stepwise approach.
• Treatment decisions, especially for grade 3 colitis, involve balancing efficacy and toxicity.
• Emerging therapies like vedolizumab offer options for refractory cases.