Abstract 3732
Background
Colitis is one of the major immune-related adverse events (irAEs) to immunotherapy that leads to significant morbidity and discontinuation of treatment. Despite being a frequent irAE, clinical presentation, endoscopic and pathological features, and management of colitis in patients (pts) treated with combination IPI+PD1 and PD1 monotherapy are not well- defined.
Methods
Pts with locally advanced or metastatic melanoma who received combination IPI+PD1 or PD1 monotherapy and developed clinically significant colitis (requiring systemic corticosteroids) were identified retrospectively from 2 academic centers. Clinical data were collected on all pts; endoscopic and histopathologic data were examined on a subset.
Results
112 patients were identified who developed significant colitis between May 2013 and October 2018; 73 treated with IPI+PD1 and 33 treated with PD1 monotherapy. Six pts were excluded from the analysis that received ipilimumab alone (3 pts) or received treatment (3 pts) on clinical trials (blinded). Endoscopic and histopathologic data were available on 63 pts. Combination therapy induced colitis was earlier onset (8.8 weeks vs 44.6 weeks, p < 0.0001) and more severe (Grade 3/4; 66% vs 31%, p = 0.0014) than with monotherapy. Infliximab and immunosuppressive agents beyond corticosteroids were required in most pts with combination therapy (54% vs 30% with monotherapy, p = 0.02). Five pts (3 combination, 2 monotherapy) underwent colectomy due to complicated steroid refractory disease (3/5 were infliximab refractory). There were no colitis related deaths. The presence of moderate to severe, diffuse inflammation was more common on combination therapy than monotherapy (51% vs 33%, p = 0.36). A chronic inflammatory infiltrate was more common on histopathology with combination colitis compared to monotherapy (46% vs 20%, p = 0.12).
Conclusions
Clinically significant colitis due to immunotherapy varies in presentation, response to immunosuppression and endoscopic/histologic features. IPI+PD1 colitis has an earlier onset, is more severe yet resistant to corticosteroids than PD1 induced colitis.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
M.S. Carlino: Honoraria (self), Advisory / Consultancy: BMS; Honoraria (self), Advisory / Consultancy: MSD; Advisory / Consultancy: Amgen; Advisory / Consultancy: Novartis; Advisory / Consultancy: Roche; Advisory / Consultancy: Pierre Fabre. R.A. Scolyer: Advisory / Consultancy: Merck Sharp & Dohme; Advisory / Consultancy: Novartis; Advisory / Consultancy: Myriad; Advisory / Consultancy: NeraCare. G.V. Long: Advisory / Consultancy: Aduro; Advisory / Consultancy: BMS; Advisory / Consultancy: MERCK MSD; Advisory / Consultancy: Mass-Array; Advisory / Consultancy: Novartis; Advisory / Consultancy: Pierre Fabre; Advisory / Consultancy: Roche. A.M. Menzies: Advisory / Consultancy: BMS; Advisory / Consultancy: Novartis; Advisory / Consultancy: MSD; Advisory / Consultancy: Roche; Advisory / Consultancy: Pierre Fabre. All other authors have declared no conflicts of interest.
Resources from the same session
3073 - 1 patient 3 different advance Ca nurse’s roles: symptom management&continuum care through a joint approach in a clinical case
Presenter: Catarina Almeida
Session: Poster Display session 3
Resources:
Abstract
4527 - Identification of malnutrition risk factors in patients with cancer in the first nursing visit
Presenter: Amaia Valverde
Session: Poster Display session 3
Resources:
Abstract
2904 - Engaging Cancer Survivors, Healthcare Providers and Advocates in The Development of a Colorectal Cancer Survivorship Information Resource: A Participatory Action Research Study
Presenter: Amanda Drury
Session: Poster Display session 3
Resources:
Abstract
3435 - Medical nurses’ experiences of the care-needs of adult patients with a primary brain tumour
Presenter: Jamila Mohammed
Session: Poster Display session 3
Resources:
Abstract
857 - Feasibility and acceptability of a mHealth intervention to increase colonoscopy uptake among Chinese first-degree relatives: a pilot cluster randomized controlled trial
Presenter: Yang Bai
Session: Poster Display session 3
Resources:
Abstract
1087 - Cancer patient participation and compliance in microbiome sample collection: an oncology research nurse’s experience
Presenter: Julie Malo
Session: Poster Display session 3
Resources:
Abstract
2783 - Implementing Digital Individual Care plans for Patients with Head and Neck cancer- Challenges and opportunities
Presenter: Helena Ullgren
Session: Poster Display session 3
Resources:
Abstract
1152 - The Effect of the Short-term and Long-term Compassion Fatigue Resiliency Program on the Quality of Life, Perceived Stress and Psychological Resilience of Oncology-Hematology Nurses
Presenter: Tugba Pehlivan
Session: Poster Display session 3
Resources:
Abstract
1172 - Competing risk analyses of overall survival and cancer-specific survival in patients with orbital rhabdomyosarcoma after surgery: a large cohort study
Presenter: Yu Zhang
Session: Poster Display session 3
Resources:
Abstract
5949 - Communication of genetic information to family members in hereditary cancers and healthcare providers’ role
Presenter: Carla Pedrazzani
Session: Poster Display session 3
Resources:
Abstract