Ipilimumab associated colitis: An IpiColitis case series at MedStar Georgetown University Hospital

Abstract

Although ipilimumab has been shown to improve survival in patients with metastatic melanoma and cause regression of metastatic renal cell carcinoma, the associated immune-related toxicities are of concern. The resultant T cell activation by this monoclonal antibody causes an increased immune response, which has been associated with many immune-regulated adverse effects. One of the most concerning effects is the development of colitis. Upwards to 8% of patients have been reported to develop colitis, with 5% being severe (Grades 3-4). While initial treatment of such adverse effects is generally comprised of supportive and symptomatic treatment, more severe cases warrant the use of high dose steroids. Furthermore, use of anti-TNF agents is usually reserved for those cases that prove to be refractory to steroids. We describe a systematic case review of seven patients who developed gastrointestinal symptoms following initiation of ipilimumab immunotherapy, and present the steps in their evaluation, treatment and outcomes at our institution.

Histopathological and immunophenotypic features of ipilimumab‐associated colitis compared to ulcerative colitis

“…The pathogenesis of colitis and other iAEs from ipilimumab remains unclear. Prior studies have described similar histopathological features in Ipi‐AC as inflammatory bowel disease (IBD) , although no study to our knowledge has directly compared these two disease entities. Although Ipi‐AC has been hypothesized to result from depletion of T regulatory (Treg) cells and activation of T effector cells in the gastrointestinal (GI) tract , studies describing the immunophenotypic features of the GI mucosa in Ipi‐AC are limited and conflicting.…”

Systematic review and case series: flexible sigmoidoscopy identifies most cases of checkpoint inhibitor‐induced colitis

“…Of the 1892 unique studies identified using our search criteria, 61 studies fulfilled our inclusion criteria and were included in the qualitative analysis (38 full text articles, 23 in abstract form) . Results of our search strategy are depicted in Figure .…”

Systematic review with meta‐analysis: effectiveness of anti‐inflammatory therapy in immune checkpoint inhibitor‐induced enterocolitis

“…Funnel plots were produced for the principal outcome for each comparison, and Egger's test of funnel plot asymmetry was used to assess publication bias. 27 All statistical analyses described above were performed using the STATA (version 16) software. Reporting of this study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.…”