Immune Checkpoint Inhibitor-associated Diarrhea and Colitis: A Systematic Review and Meta-analysis of Observational...

Area of Science:

• Oncology
• Immunology
• Gastroenterology

Background:

• Immune checkpoint inhibitors (ICIs) have revolutionized advanced cancer treatment.
• Diarrhea and colitis are significant side effects of ICI therapy.
• Understanding the incidence and outcomes of these gastrointestinal toxicities is crucial for patient management.

Purpose of the Study:

• To systematically review and meta-analyze the incidence and outcomes of diarrhea and colitis associated with ICI therapy.
• To compare the incidence of these side effects between different types of ICIs.
• To evaluate the effectiveness of different treatment strategies for ICI-induced diarrhea and colitis.

Main Methods:

• Systematic review and meta-analysis of observational studies.
• Searched bibliographic databases up to August 13, 2019.
• Included 25 studies with 12,661 patients, analyzing incidence, treatment, and outcomes.
• Employed random-effects models for meta-analyses.

Main Results:

• Overall incidence of diarrhea/colitis was 12.8%, higher with anti-cytotoxic T-cell lymphocyte-associated antigen 4 (20.1%) than anti-programmed cell death 1/programmed death-ligand 1 (4.1%).
• Remission rates were higher with corticosteroids plus biologics (88.4%) compared to corticosteroids alone (58.3%).
• Permanent ICI discontinuation occurred in 48.1% of patients; 48.6% resumed therapy with a 17.0% recurrence rate.

Conclusions:

• Real-world incidence of ICI-associated diarrhea/colitis exceeds 10%, leading to permanent discontinuation in over 50% of cases.
• Combination therapy with corticosteroids and biologics significantly improves remission.
• Further research is needed to guide early biologic treatment and safe resumption of ICI therapy.