Microbiome alteration Via Fecal Microbiota Transplantation Is Effective For Refractory Immune Checkpoint inhibitor-induced Colitis

Authors

Taylor M Halsey
Anusha S Thomas
Tomo Hayase
Weijie Ma
Hamzah Abu-Sbeih
Baohua Sun
Edwin Roger Parra
Zhi-Dong Jiang
Herbert L DuPont
Christopher Sanchez
Rawan El-Himri
Alexandria Brown
Ivonne Flores
Lauren McDaniel
Miriam Ortega Turrubiates
Matthew Hensel
Dung Pham
Stephanie S Watowich
Eiko Hayase
Chia-Chi Chang
Robert R Jenq
Yinghong Wang

Publication Date

6-14-2023

Journal

Science Translational Medicine

Abstract

Immune checkpoint inhibitors (ICIs) target advanced malignancies with high efficacy but also predispose patients to immune-related adverse events like immune-mediated colitis (IMC). Given the association between gut bacteria with response to ICI therapy and subsequent IMC, fecal microbiota transplantation (FMT) represents a feasible way to manipulate microbial composition in patients, with a potential benefit for IMC. Here, we present a large case series of 12 patients with refractory IMC who underwent FMT from healthy donors as salvage therapy. All 12 patients had grade 3 or 4 ICI-related diarrhea or colitis that failed to respond to standard first-line (corticosteroids) and second-line immunosuppression (infliximab or vedolizumab). Ten patients (83%) achieved symptom improvement after FMT, and three patients (25%) required repeat FMT, two of whom had no subsequent response. At the end of the study, 92% achieved IMC clinical remission. 16

Keywords

Immune Checkpoint Inhibitors, Colitis, Fecal Microbiota Transplantation, RNA, Ribosomal, 16S, Feces, Humans, Male, Female, Middle Aged, Aged