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Workup and Management of Immune-Mediated Colitis in Patients Treated with Immune Checkpoint Inhibitors

Bhavana Pendurthi Singh1, John L Marshall1, Aiwu Ruth He1

  • 1Ruesch Center for the Cure of Gastrointestinal Cancers, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.

The Oncologist
|March 13, 2020
PubMed

Insights

Immune checkpoint inhibitors are increasingly used for cancer treatment, but can cause immune-mediated colitis. This review details the diagnosis and management of this common side effect, ranging from supportive care to advanced therapies like steroids and TNF inhibitors.

Area of Science:

  • Oncology
  • Immunology
  • Gastroenterology

Background:

  • Immune checkpoint inhibitors (ICIs) are widely adopted for treating various malignancies, with the first approved in 2011 for advanced melanoma.
  • The increasing use of ICIs necessitates a focus on managing their associated immune-mediated toxicities, particularly immune-mediated colitis.

Purpose of the Study:

  • To review the diagnostic workup for immune-mediated colitis.
  • To outline management strategies for immune-mediated colitis based on severity.

Main Methods:

  • Diagnostic workup involves ruling out infectious causes of diarrhea, colonoscopy, and abdominal imaging.
  • Management strategies include supportive therapies for mild cases, corticosteroids for moderate to severe cases, and tumor necrosis factor (TNF) inhibitors (e.g., infliximab) for refractory cases.

Main Results:

  • Immune-mediated colitis is a common toxicity associated with immune checkpoint inhibitors.
  • The rate of immune-mediated colitis varies depending on the specific ICI treatment used.
  • A systematic approach combining diagnostic tests and tiered management strategies is crucial.

Conclusions:

  • Prompt diagnosis and appropriate management are essential for addressing immune-mediated colitis.
  • Treatment approaches range from supportive care to immunomodulatory agents, tailored to disease severity.
  • Understanding and managing ICI-induced colitis is critical for optimizing cancer treatment outcomes.

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