Efficacy and safety of vedolizumab and infliximab treatment for immune-mediated diarrhea and colitis in patients with cancer: a two-center observational study

Abstract

BackgroundCurrent treatment guidelines for immune-mediated diarrhea and colitis (IMDC) recommend steroids as first-line therapy, followed by selective immunosuppressive therapy (SIT) (infliximab or vedolizumab) for refractory cases. We aimed to compare the efficacy of these two SITs and their impact on cancer outcomes.MethodsWe performed a two-center, retrospective observational cohort study of patients with IMDC who received SITs following steroids from 2016 to 2020. Patients’ demographic, clinical, and overall survival data were collected and analyzed.ResultsA total of 184 patients (62 vedolizumab, 94 infliximab, 28 combined sequentially) were included. The efficacy of achieving clinical remission of IMDC was similar (89% vs 88%, p=0.79) between the two groups. Compared with the infliximab group, the vedolizumab group had a shorter steroid exposure (35 vs 50 days, p<0.001), fewer hospitalizations (16% vs 28%, p=0.005), and a shorter hospital stay (median 10.5 vs 13.5 days, p=0.043), but a longer time to clinical response (17.5 vs 13 days, p=0.012). Longer durations of immune checkpoint inhibitors treatment (OR 1.01, p=0.004) and steroid use (OR 1.02, p=0.043), and infliximab use alone (OR 2.51, p=0.039) were associated with higher IMDC recurrence. Furthermore, ≥3 doses of SIT (p=0.011), and fewer steroid tapering attempts (p=0.012) were associated with favorable overall survival.ConclusionsTreatment with vedolizumab as compared with infliximab for IMDC led to comparable IMDC response rates, shorter duration of steroid use, fewer hospitalizations, and lower IMDC recurrence, though with slightly longer time to IMDC response. Higher number of SIT doses was associated with better survival outcome, while more steroid exposure resulted in worse patient outcomes.

Monitoring and Management of the Patient with Immune Checkpoint Inhibitor-Induced Inflammatory Arthritis: Current Perspectives

“…Along these lines, a retrospective study of 184 patients with ICI-colitis that compared patients treated with infliximab, a TNFi, to vedolizumab, which targets integrin α 4 β 7 and prevents gut but not systemic inflammation, showed infliximab to be associated with a higher rate of cancer progression. 72 …”

Vedolizumab Attenuates Immune-Checkpoint-Therapy-Induced Infliximab-Refractory Colitis

“…Other studies have shown that vedolizumab is associated with a clinical response rate of 95% in patients with ICI-induced colitis who did not receive prior infliximab, with an endoscopic remission rate > 50% [ 30 ]. The vedolizumab-alone group had the lowest rate of colitis recurrence compared with the infliximab-alone group, and patients received combined selective immunosuppressive therapies sequentially [ 31 ]. It might be better to switch to vedolizumab treatment in recurrent refractory cases against infliximab.…”

The “Great Debate” at Melanoma Bridge 2021, December 2nd–4th, 2021

“…Vedolizumab is a humanized monoclonal antibody used to treat ulcerative colitis, which acts by binding to α4β7 integrin on T lymphocytes, thereby reducing lymphocyte trafficking to the gut. In a retrospective study of 184 patients with cancer and immune-mediated diarrhea and colitis (IMDC), treatment with vedolizumab led to a similar IMDC response rate as infliximab treatment [ 37 ]. However.…”