P2053 - Establishing Upper GI Toxicity Remission With Vedolizumab Maintenance Therapy While Resuming Immune Checkpoint Inhibitor

Award: Presidential Poster Award

Award: Presidential Poster Award

Antony Mathew, MD¹, Yinghong Wang, MD, PhD, MS^2
1UT Health McGovern Medical School, Houston, TX; ²University of Texas MD Anderson Cancer Center, Houston, TX

Introduction: The clinical benefits of immune checkpoint inhibitors (ICIs) have been associated with immune-related adverse events (irAEs), with gastrointestinal (GI) irAEs among the most reported. However, upper GI toxicity is not as common but severe cases can still necessitate interruption of ICI therapy and require treatment with immunosuppression, either with corticosteroids or biologic therapy such as TNF-α inhibitor (infliximab) or anti-integrin antibodies (vedolizumab), which could compromise cancer outcomes. We present a case series of 4 patients with ICI induced upper GI toxicity, treated with corticosteroids and vedolizumab and then successfully resumed on ICI treatment with vedolizumab maintenance therapy.

Case Description/Methods: Of the 4 patients in our series, all had metastatic malignancies that were treated with an ICI. All patients developed GI irAE with endoscopic confirmation of upper GI toxicity. Patient A presented with nausea, vomiting and early satiety after completing 19 cycles of pembrolizumab. The patient was found to have severe gastritis that required prednisone followed by vedolizumab. Subsequently, pembrolizumab was successfully resumed with concurrent vedolizumab maintenance. Patient B developed epigastric pain and nausea after 15 cycles of pembrolizumab. The patient’s symptoms were refractory to corticosteroids but responded to vedolizumab which enabled him to continue pembrolizumab therapy. Patient C presented with nausea and vomiting while on pembrolizumab therapy. Given his persistent symptoms, the patient was treated and responded to prednisone and vedolizumab for presumed ICI related upper GI toxicity despite only mild gastritis on histology. Subsequently, patient was transitioned to lenvatinib and everolimus for cancer treatment while on vedolizumab maintenance therapy. Patient D developed diarrhea, hematochezia and abdominal pain while on sitravatinib, nivolumab and ipilimumab, and was confirmed to have both upper and lower GI tract inflammation. The patient was successfully treated with methylprednisolone and vedolizumab, with plans to resume ICI while on vedolizumab maintenance.

Discussion: 1) As the use of ICI expands, it is imperative to identify appropriate management strategies to treat irAE and reduce recurrence.

2) These cases highlight an effective management strategy of vedolizumab maintenance for ICI related upper GI toxicity with ICI resumption.

3) Further prospective large-scale studies are still required to assess the efficacy of this treatment strategy.


Figure: A, B) Patient A-Diffuse moderately congested gastric mucosa with friable exudates.
C, D) Patient A- Follow up endoscopy reveals improvement in gastric mucosa.

Table: Patient Characteristics


Disclosures:
Antony Mathew indicated no relevant financial relationships.
Yinghong Wang: AzurRx Biopharma – Consultant. Tillotts Pharma – Consultant.


Antony Mathew, MD¹, Yinghong Wang, MD, PhD, MS². P2053 - Establishing Upper GI Toxicity Remission With Vedolizumab Maintenance Therapy While Resuming Immune Checkpoint Inhibitor, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.