P105 SHORT TERM ENDOSCOPIC FOLLOW UP ON IMMUNO-CHECKPOINT INHIBITOR INDUCED COLITIS POST TREATMENT. (18th January 2018)

• Record Type: Journal Article
• Authors: Ali, Faisal S; Abu-Sbeih, Hamzah; Samdani, Rashmi; Wang, Yinghong
• Is Part Of: Inflammatory bowel diseases. Volume 24(2018)Supplement 1
• Page Start: S37
• Page End: S37
• Publication Date: 2018-01-18
• Subjects: Inflammatory bowel diseases -- Periodicals; Colitis, Ulcerative -- Periodicals; Crohn Disease -- Periodicals; Inflammatory Bowel Diseases -- Periodicals; 616.344
• DOI: 10.1093/ibd/izy019.117
• Languages: English
• ISSNs: 1078-0998

Abstract

Abstract: Background: Immuno-checkpoint inhibitor induced colitis (ICI-C) is a serious adverse event (AE) and can persist months after stopping the triggering ICI. Clinical symptoms resolution does not always correlate with endoscopic/histological findings. We report a case series with discordance between symptom profile and endoscopic/histological findings of colitis. Case 1: A 77 y/o male with prostate cancer, experienced 8–11 bloody stools 3 months after 2nd dose ipilimumab. Colonoscopy revealed multiple large ulcerations throughout, with biopsy showing chronic active colitis. Patient's symptoms partially improved after treatment with high dose steroids for 2 months, and 2 doses of infliximab, resolved after adding 3 doses of vedolizumab. Colonoscopy after 5 months of treatment showed persistent ulcers. Case 2: A 51 y/o male with bladder cancer treated with atezolizumab developed grade 2–3 diarrhea a week after the 2nd dose. Colonoscopy showed normal mucosa with biopsy revealing lymphocytic colitis. The patient failed mesalamine and high dose steroids, resolved with 2 doses of infliximab. Symptoms recurred 3 months later. Repeat biopsy of the colon showed persistent colitis. 2 more doses of infliximab was given with symptoms resolution. Case 3: A 66 y/o male with metastatic melanoma treated with ipilimimab and pembrolizumab experienced grade 3 diarrhea after 2nd dose. A colonoscopy revealed mild patchy erythema in the colon. Biopsy revealed moderate active colitis. Symptoms improved to grade 1 after steroids and 4 doses of infliximab. Repeat colonoscopy showed normal mucosa, with biopsy showing persistent active colitis. Conclusion: The symptoms of ICI-C do not always correlate with endoscopic/histological findings. Persistent endoscopic/histological inflammation likely predict recurrent symptoms, despite short term clinical remission. Deeper level remission may be a better surrogate marker for good long term outcome.