Refractory Checkpoint Inhibitor Colitis Responsive to Ustekinumab.
Genesis Perez Del Nogal1, Neha Patel2
1Texas Tech University Health Sciences Center School of Medicine, Odessa, TX.
ACG Case Reports Journal
|January 5, 2023
Summary
Immune checkpoint inhibitors can cause severe colitis. Ustekinumab effectively treated a refractory case of pembrolizumab-induced colitis after other therapies failed, offering new hope for patients.
Area of Science:
- Oncology
- Immunology
- Gastroenterology
Background:
- Immune checkpoint inhibitors (ICIs) revolutionized cancer therapy but can induce immune-related adverse events, notably colitis.
- Checkpoint inhibitor colitis (CIC) can be severe, leading to complications like intestinal perforation and death.
- Standard treatments include steroids and TNF-alpha inhibitors (e.g., infliximab), with vedolizumab and fecal microbiota transplantation for refractory cases.
Observation:
- This report details a patient with Stage IV anaplastic thyroid carcinoma treated with pembrolizumab.
- The patient developed steroid-refractory checkpoint inhibitor-induced colitis.
- Previous treatments with infliximab, vedolizumab, and fecal microbiota transplantation were unsuccessful.
Findings:
- Ustekinumab, a biologic targeting IL-12/23, was administered to the patient with refractory CIC.
- Successful resolution of severe colitis was achieved with ustekinumab treatment.
- This represents the first reported case of ustekinumab successfully treating ICI-induced colitis.
Implications:
- Ustekinumab may represent a novel therapeutic option for refractory immune checkpoint inhibitor colitis.
- This finding could expand treatment strategies for severe immune-related adverse events associated with ICIs.
- Further research is warranted to explore ustekinumab's efficacy and safety in a broader patient population with refractory CIC.
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