From the Guidelines
The treatment for checkpoint inhibitor-induced colitis typically begins with high-dose systemic glucocorticoids, given in doses of 0.5–2 mg/kg prednisone equivalent daily with a taper of 4–6 weeks, as recommended by the American Gastroenterological Association 1.
Key Considerations
- Infectious causes of diarrhea should be excluded before treatment of suspected ICI colitis 1.
- Early stool testing for inflammatory markers (lactoferrin and calprotectin) may help stratify high-risk patients for endoscopic evaluation 1.
- Endoscopic confirmation of the diagnosis and severity of ICI colitis should be considered before initiation of high-dose systemic glucocorticoids 1.
Treatment Approach
- For moderate cases, prednisone 1-2 mg/kg/day or methylprednisolone 1-2 mg/kg/day may be used 1.
- For severe cases, hospitalization and intravenous steroids may be necessary, and infliximab (5 mg/kg) or vedolizumab may be considered as alternative treatments 1.
- Supportive care includes hydration, electrolyte replacement, and antidiarrheal medications for mild symptoms.
Multidisciplinary Approach
- A multidisciplinary approach involving oncology and gastroenterology is essential for managing checkpoint inhibitor-induced colitis 1.
- The checkpoint inhibitor therapy should be temporarily held during treatment of moderate to severe colitis.
Alternative Treatments
- For steroid-refractory cases, infliximab or vedolizumab may be considered as alternative treatments 1.
- Fecal microbiota transplantation has been reported as a potential treatment option for patients who fail both vedolizumab and infliximab 1.
From the Research
Treatment Options for Checkpoint Inhibitor-Induced Colitis
- The treatment for checkpoint inhibitor-induced colitis typically involves the use of corticosteroids and/or infliximab, with most patients experiencing full resolution of symptoms 2, 3, 4, 5.
- For cases that are refractory to treatment, alternative strategies such as vedolizumab and fecal microbiota transplantation may be considered 2, 5, 6.
- The use of vedolizumab has been shown to be effective in treating immune-mediated diarrhea and colitis that is refractory to steroids and/or infliximab, with favorable outcomes and a good safety profile 6.
Management of Checkpoint Inhibitor-Induced Colitis
- Prompt diagnosis and management of checkpoint inhibitor-induced colitis is crucial for optimal outcome, as mild to severe colitis can occur and may progress to more serious complications such as bowel perforation and death 2, 4.
- A definitive diagnosis can only be rendered after excluding other possible etiologies, and an extensive clinical, laboratory, and radiologic workup may be required 2.
- Endoscopic investigations, such as rectosigmoïdoscopy or colonoscopy, should be performed when severe checkpoint inhibitor-induced colitis is suspected, but should not delay treatment 4.
Efficacy and Safety of Treatment
- The efficacy and safety of treatment for checkpoint inhibitor-induced colitis has been studied, with infliximab and corticosteroids showing promise in achieving complete remission 3.
- However, high doses of prednisolone at the start of tapering have been associated with increased mortality, and a high incidence of infections and hospitalizations has been observed in patients with severe immune-mediated enterocolitis 3.
- Vedolizumab has been shown to be effective in achieving clinical remission in patients with immune-mediated diarrhea and colitis, with a good safety profile 6.