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Characteristics and outcomes of cancer patients with pre-existing microscopic colitis after exposure to PD-1 and PD-L1 inhibitors

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Abstract

Purpose

Immune checkpoint inhibitors (ICIs) are frequently associated with adverse events, often affecting the gastrointestinal tract. We conducted this study to determine the characteristics and outcomes of cancer patients with pre-existing microscopic colitis (MC) who underwent ICI treatment.

Methods

In this retrospective study, we identified 10 patients with pre-existing MC who received ICIs at our center 01/2010–06/2020. Clinical characteristics and disease outcomes were recorded.

Results

Of 124 screened patients with MC before ICI exposure, 10 had sufficient data to be included in the study. Melanoma (40%) and lung cancer (30%) were the most prevalent cancer types, with 70% of stage IV cancer. Patients received either anti-programmed death 1 regimen (8, 80%) or anti-programmed death ligand 1 agent (2, 20%). Six patients (60%) had collagenous colitis, and 4 (40%) had lymphocytic colitis. The median time from MC diagnosis to ICI initiation was 4 years, with 1 patient on budesonide within 2 months of ICI initiation. Eight patients (80%) developed colitis exacerbations after ICI  and required selective immunosuppression. One patient received a compassionate-use fecal transplantation. The median time from ICI to colitis exacerbation was 14 days, with 40% and 50% of patients experiencing grade 3 diarrhea and grade 2 colitis, respectively, leading to hospitalization in 3 patients. Six patients received steroids and vedolizumab with no colitis recurrence. Of 8 patients who had colitis exacerbation, 6 resumed ICI therapy afterward; with 5 receiving concomitant vedolizumab for secondary prophylaxis.

Conclusion

Our findings suggest that ICI exposure increases the risk of exacerbation of underlying colitis necessitating and responding to potent immunosuppression therapy.

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Data availability

The datasets used and analyzed in this study are available from the corresponding author upon reasonable request.

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Acknowledgements

Medical editing of this paper was provided by Laura L. Russell in the Research Medical Library at The University of Texas MD Anderson Cancer Center.

Funding

This study was not supported by any funding.

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Author notes

  1. Anusha S. Thomas and Yinghong Wang Co-senior authors.

Authors and Affiliations

  1. Department of Internal Medicine, The University of Texas Health Science Center, Houston, TX, USA

    Austin R. Thomas

  2. Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA

    Cynthia Liu

  3. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Yi T. Tong & Dongfeng Tan

  4. Department of Thoracic, Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Mehmet Altan

  5. Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Bilal A. Siddiqui

  6. Department of Gastroenterology, Hepatology and Nutrition, Unit 1466, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA

    Malek Shatila, Anam Khan, Anusha S. Thomas & Yinghong Wang

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Contributions

YW and AT were the senior authors of the study, developed the concept, designed the study, interpreted the results, ensured the preservation of data accuracy and integrity at all stages, agreed to be accountable for all aspects of the study, were in charge of the overall direction and planning of the study, and contributed to the writing of the manuscript with input from all authors. AT and CL collected the data for the study, conducted the analysis, interpreted the results, and wrote the manuscript. YT and DT collected the pathology images. MA, BAS, MS, and AK critically revised the final version of the manuscript. All authors had access to the study data and reviewed and approved the final manuscript.

Corresponding author

Correspondence to Yinghong Wang.

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Competing interests

The authors declare no competing interests.

Conflict of interest

None of the authors have competing interests.

Ethics approval and consent to participate

Ethics approval for this study was granted by the Institutional Review Board of the University of Texas MD Anderson Cancer Center (PA18-0472). Patient consent was waived for this study.

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Thomas, A.R., Liu, C., Tong, Y.T. et al. Characteristics and outcomes of cancer patients with pre-existing microscopic colitis after exposure to PD-1 and PD-L1 inhibitors. J Cancer Res Clin Oncol 149, 5429–5436 (2023). https://doi.org/10.1007/s00432-022-04499-9

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  • DOI: https://doi.org/10.1007/s00432-022-04499-9

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