P1194 - Initial Pattern of Colitis Is Associated With Disease Outcomes in Patients With Immune Checkpoint Colitis

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Lawrence Kogan, MD

Brown University
Providence, RI, United States

Lawrence Kogan, MD¹, Sarah Abou Alaiwi, MD², Dhanya Raj, MD², Sophie Barnes, EdM³, Osama E. Rahma, MD⁴, Amitabh Srivastava, MD², Shilpa Grover, MD, MPH²
¹Brown University, Providence, RI; ²Brigham & Women's Hospital, Boston, MA; ³Harvard University, Providence, RI; ⁴Dana Farber Cancer Institute, Boston, MA

Introduction: A spectrum of histopathologic changes have been associated with immune checkpoint inhibitors (ICIs). This study aimed to evaluate differences in disease severity and treatment course based on the morphological pattern of initial ICI colitis.

Methods: We retrospectively reviewed records of cancer patients treated at our institution who received at least 1 dose of either a programmed cell death-1 (PD-1)/ PD-1 ligand (PD-L1) inhibitor, cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) inhibitor, or both between 2011 and 2019 and identified patients with biopsy proven ICI colitis. Pathology results from their first diagnostic colonic biopsy were classified into three patterns: active colitis (diffuse active, graft-versus-host-like or mixed), chronic active colitis, or microscopic colitis (lymphocytic or collagenous colitis). We evaluated the association between these histopathologic patterns and clinical and treatment characteristics.

Results: We retrospectively reviewed records of cancer patients treated at our institution who received at least 1 dose of either a programmed cell death-1 (PD-1)/ PD-1 ligand (PD-L1) inhibitor, cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) inhibitor, or both between 2011 and 2019 and identified patients with biopsy proven ICI colitis. Pathology results from their first diagnostic colonic biopsy were classified into three patterns: active colitis (diffuse active, graft-versus-host-like or mixed), chronic active colitis, or microscopic colitis (lymphocytic or collagenous colitis). We evaluated the association between these histopathologic patterns and clinical and treatment characteristics.

Discussion: Although active colitis was the most prevalent histopathologic pattern in patients with ICI colitis, a notable proportion of patients have microscopic colitis or chronic active colitis on initial biopsy. The majority of patients with ICI-induced microscopic colitis required prednisone and nearly one-fourth required a biologic agent. The presence of chronic colitis on initial biopsy was associated with the need for maintenance biologic therapy. Initial biopsy results are predictive of the clinical course in patients with ICI colitis and may be used to guide therapy.

		All Colitis (n=195)	Active Colitis (n=109)	Chronic Active Colitis (n=35)	Microscopic Colitis (n=51)	p value
Mean age (standard deviation)		64.0 (10.9)	63.4 (10.6)	64.7 (10.4)	64.6 (11.3)	0.717
Sex	Female	101	57 (52.3%)	14 (40%)	30 (58.8%)	0.23
Sex	Male	94	52 (47.7%)	21 (60%)	21 (41.2%)
ICI Class	CTLA-4 Monotherapy	44	36 (33%)	3 (8.6%)	5 (9.8%)	< 0.001
	PD-1/PD-L1 Monotherapy	95	37 (33.9%)	24 (68.6%)	34 (66.7%)
	Combination Therapy	56	36 (33%)	8 (22.9%)	12 (23.5%)
Endoscopic Mayo Score	0	59	28 (25.9%)	5 (14.7%)	26 (54.2%)	< 0.001
	1	61	30 (27.8%)	10 (29.4%)	21 (43.8%)
	2	49	33 (30.6%)	15 (44.1%)	1 (2.1%)
	3	21	17 (15.7%)	4 (11.8%)	0 (0%)
Hospitalized for ICI colitis	No	70	30 (26.3%)	26 (51%)	14 (46.7%)	0.004
Hospitalized for ICI colitis	Yes	125	84 (73.7%)	25 (49%)	16 (53.3%)
Mean number of steroid courses for ICI colitis (standard deviation)		1.73 (1.07)	1.87 (1.09)	1.57 (1.01)	1.54 (1.06)	0.86
Biologic required for ICI colitis	No	108	50 (45.9%)	18 (51.4%)	40 (78.4%)	< 0.001
Biologic required for ICI colitis	Yes	87	59 (54.1%)	17 (48.6%)	11 (21.6%)
Maintenance infliximab ( >3 doses) required for ICI colitis	No	64	47 (92.2%)	8 (53.3%)	9 (90%)	0.003
Maintenance infliximab ( >3 doses) required for ICI colitis	Yes	12	4 (7.8%)	7 (46.7%)	1 (10%)
Maintenance vedolizumab ( > 3 doses) required for ICI colitis	No	10	7 (63.6%)	1 (25%)	2 (100%)	0.37
	Yes	7	4 (36.4%)	3 (75%)	0 (0%)

Table: Basic demographics, clinical course and treatment outcomes based on histopathology from patients' first colonic biopsy.

Disclosures:

Lawrence Kogan indicated no relevant financial relationships.

Sarah Abou Alaiwi indicated no relevant financial relationships.

Dhanya Raj indicated no relevant financial relationships.

Sophie Barnes indicated no relevant financial relationships.

Osama Rahma: Boehringer Ingelheim – Advisory Committee/Board Member. GSK – Advisory Committee/Board Member. Sobi – Advisory Committee/Board Member.

Amitabh Srivastava indicated no relevant financial relationships.

Shilpa Grover: UpToDate, Wolters Kluwer, Inc – Employee.

Lawrence Kogan, MD¹, Sarah Abou Alaiwi, MD², Dhanya Raj, MD², Sophie Barnes, EdM³, Osama E. Rahma, MD⁴, Amitabh Srivastava, MD², Shilpa Grover, MD, MPH². P1194 - Initial Pattern of Colitis Is Associated With Disease Outcomes in Patients With Immune Checkpoint Colitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.