Imaging and clinical manifestations of immune checkpoint inhibitor-related colitis in cancer patients treated with monot
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Imaging and clinical manifestations of immune checkpoint inhibitor‑related colitis in cancer patients treated with monotherapy or combination therapy Alice C. Shieh1 · Ezgi Guler1 · David Pfau1 · Ethan Radzinsky1 · Daniel A. Smith1 · Christopher Hoimes2 · Nikhil H. Ramaiya1 · Sree Harsha Tirumani1
© Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Purpose To determine the frequency, imaging, and clinical manifestations of immune checkpoint inhibitor (ICI)-related colitis in cancer patients on monotherapy or combination therapy. Methods The electronic medical records of 1044 cancer patients who received ICIs were retrospectively reviewed to identify 48 patients who had a clinical diagnosis of immune-related colitis. Imaging studies were reviewed to identify patients with imaging manifestations of colitis. Demographic data, type of ICIs, symptoms, presence of other immune-related adverse events (irAEs), and management were recorded. Results There was imaging evidence of immune-related colitis in 34 patients (24 men; median age: 63.5 years). The median time to onset of colitis was 75 days (IQR 25–75, 49.5–216 days) in patients receiving monotherapy (group 1) and 78 days (IQR 25–75, 44.3–99.5 days) in patients undergoing combination therapy (group 2) following start of ICI. Symptoms included diarrhea (91.1% [31 of 34]), nausea/vomiting (52.9% [18 of 34]), and abdominal pain (52.9% [18 of 34]). The most common imaging findings were bowel wall thickening (97% [33 of 34]) and fluid-filled colon (82.3% [28 of 34]). Colitis was diffuse in 21 of 34 (61.8%) patients. Imaging manifestations did not differ between the two groups (p > 0.05). Steroids and antibiotics were used to treat colitis in 29 of 34 (85.2%) and 13 of 34 (38.2%) patients, respectively. No patients in group 1 experienced concurrent irAEs, but 5 of 18 (27.8%) of patients in group 2 had other irAEs (p = 0.046). Conclusion Immune-related colitis occurred in 3.3% of patients receiving ICIs with bowel wall thickening, fluid-filled colon and pancolitis being the most common imaging manifestations. Imaging manifestations did not differ between patients receiving monotherapy or combination therapy. However, concurrent irAEs were significantly observed in patients undergoing combination therapy. Keywords Colitis · Adverse drug event · Neoplasms · Diagnostic imaging
Introduction Immune checkpoint inhibitors (ICIs) are used to treat cancer by effectively stimulating the immune system to attack cancer cells. Ipilimumab is a recombinant human monoclonal antibody that binds to the cytotoxic T-lymphocyte associated * Ezgi Guler [email protected] 1
Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, USA
Department of Hematology and Oncology, University Hospitals Cleveland Medical Center, Cleveland, USA
2
antigen 4 (CTLA-4), which is a down-regulator of T-cell activation pathways. It was approved by the United States Federal Drug Administration (FDA) in 2011 for treatment of late-
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