Immune Checkpoint Inhibitor-Related Gastrointestinal Toxicity in Patients With Malignancy Involving the Luminal Gastrointestinal Tract and Its Impact on Cancer Outcomes

Authors

Kevin Yu
Antony Mathew
Fiyinfoluwa Abraham
Rajan Amin
Miho Kono
Michael Overman
Dan Zhao
Anam Khan
Muhammad A Khan
Anusha S Thomas
Yinghong Wang

Publication Date

1-1-2022

Journal

Annals of Gastroenterology

DOI

10.20524/aog.2022.0742

PMID

36061157

PMCID

PMC9399574

PubMedCentral® Posted Date

7-30-2022

PubMedCentral® Full Text Version

Post-print

Abstract

Background: Immune checkpoint inhibitors (ICI) are known to cause immune-related adverse events (irAE) with the gastrointestinal (GI) tract among the most affected. Our knowledge of GI irAE in patients with luminal GI malignancies is poor. We aimed to characterize the incidence, clinical features, treatment, and outcomes of these GI irAEs.

Methods: This was a retrospective study of patients with malignancies involving the luminal GI tract and GI irAEs at MD Anderson Cancer Center from January 2010 to June 2020. Clinical data were collected and analyzed.

Results: Eighteen patients with luminal GI tract malignancies treated with ICIs had evidence of GI irAEs based on clinical symptoms and/or histology. The predominant GI irAE symptom was diarrhea (78%). Ten had non-ulcerative inflammation (56%) and 5 had ulcerative inflammation (28%) on endoscopy. Histologically, 3 patients (17%) had evidence of acute inflammation, 4 (22%) had chronic inflammation, and 9 (50%) had both. Ten patients (56%) received immunosuppressant treatment, which included steroids alone (n=2, 20%), steroids with biologics (infliximab or vedolizumab) (n=7, 70%), or biologics alone (n=1, 10%), with clinical remission in all cases. Of the 6 patients who previously had stable or ICI-responsive cancer and received immunosuppressants, none developed progression of GI luminal malignancy during the study period.

Conclusions: GI irAEs occurred in 2.4% of patients treated with ICI for cancer involving the luminal GI tract. Immunosuppressant therapies (e.g., vedolizumab) appear to be effective for GI irAEs, showing no association with further GI luminal cancer progression, recurrence, or a subsequent poor response to ICI therapy.

Keywords

Immune checkpoint inhibitor, GI luminal malignancy, colitis, outcome

Published Open-Access

yes

Recommended Citation

Yu, Kevin; Mathew, Antony; Abraham, Fiyinfoluwa; et al., "Immune Checkpoint Inhibitor-Related Gastrointestinal Toxicity in Patients With Malignancy Involving the Luminal Gastrointestinal Tract and Its Impact on Cancer Outcomes" (2022). Faculty, Staff and Student Publications. 4938.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/4938