E0104 - Characteristics and Outcomes of Cancer Patients With Pre-existing Microscopic Colitis After Exposure to Immune Checkpoint Inhibitors

Tuesday, October 25, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Austin R. Thomas, DO

University of Texas Health Science Center
Houston, TX

Austin R. Thomas, DO¹, Cynthia Liu, MD², Yi Tat Tong, DO³, Dongfeng Tan, MD⁴, Mehmet Altan, MD⁴, Bilal A. Siddiqui, MD⁵, Anam Khan, MD⁴, Anusha S. Thomas, MD⁴, Yinghong Wang, MD, PhD⁴
¹University of Texas Health Science Center, Houston, TX; ²University of Texas MD Anderson Cancer Center, Houston, TX; ³UT MDACC, Houston, TX; ⁴MD Anderson Cancer Center, Houston, TX; ⁵The University of Texas MD Anderson Cancer Center, Houston, TX

Introduction: Immune checkpoint inhibitors (ICIs) are frequently associated with adverse events, often affecting the gastrointestinal tract. We conducted this study to determine the characteristics and outcomes of cancer patients with pre-existing microscopic colitis (MC) who underwent ICI treatment.

Methods: In this retrospective study, we identified 10 patients with pre-existing MC who received ICIs at our center 01/2010-06/2020. Clinical characteristics and disease outcomes were recorded.

Results: Of the 124 screened patients with MC before ICI exposure, 10 had sufficient data to be included in the study. Melanoma (40%) and lung cancer (30%) were the most prevalent cancer types, with 70% of stage IV cancer. Most patients (90%) received anti–programmed death ligand 1 monotherapy. Six patients (60%) had collagenous colitis, and 4 (40%) had lymphocytic colitis. The median time from MC diagnosis to ICI initiation was 4 years, with 1 patient on budesonide within 2 months of ICI initiation. Eight patients (80%) developed colitis exacerbations after ICI subsequently requiring selective immunosuppression. One patient received a compassionate-use fecal transplantation. The median time from ICI initiation to colitis exacerbation was 14 days, with 40% and 50% of patients experiencing grade 3 diarrhea and grade 2 colitis, respectively, and leading to hospitalization in 3 patients. Six patients received steroids and vedolizumab with no colitis recurrence. Of the 8 patients who had colitis exacerbations, 6 resumed ICI therapy afterwards; with 5 receiving concomitant vedolizumab for secondary prophylaxis.

Discussion: Our findings suggest that ICI exposure in patients with pre-existing MC increases the risk of exacerbation of underlying colitis necessitating and responding to potent immunosuppression therapy.

Characteristic	Value
MC status after ICI initiation, no. (%)
Persistent symptoms	2 (20)
Exacerbation of colitis	8 (80)
Median time from ICI initiation to colitis exacerbation, days (IQR) (N=8)	14 (8-128)
Highest grade of diarrhea after ICI initiation, no. (%)
1	4 (40)
2	2 (20)
3	4 (40)
Highest grade of colitis after ICI initiation, no. (%)
0	2 (20)
1	3 (30)
2	5 (50)
Median duration of initial colitis exacerbation symptoms, months (IQR) (N = 8)	4 (2-6)
Hospitalization, no. (%)	3 (30)
Median duration of hospitalization, days (IQR) (N = 3)	5 (4.5-7)
ICU admission for colitis, no. (%)	0 (0)
Positive lactoferrin, no. (%) (N = 9)	6 (67)
Median peak fecal calprotectin, mcg/gm (IQR) (N = 8)	368 (119-591)
Treatment of colitis exacerbation, no. (%) (N = 8)
Mesalamine	1 (12.5)
Systemic corticosteroids	8 (100)
Vedolizumab/ustekinumab (in addition to systemic corticosteroids)	8 (100)
Fecal microbiota transplantation	1 (12.5)
Endoscopic presentation after ICI initiation, no. (%) (N = 7)
Mucosal ulceration	1 (14)
Nonulcerative inflammation	1 (14)
Normal	5 (72)
Presence of histologic inflammation	6 (86)
Subsequent recurrent colitis – no. (%)	2 (25)
Mortality due to MC, no. (%)	0 (0)
Abbreviations: GI, denotes gastrointestinal; ICU, intensive care unit; IQR, interquartile range; MC microscopic colitis.

Table: Colitis characteristics after ICI (N=10)

Disclosures:

Austin Thomas indicated no relevant financial relationships.

Cynthia Liu indicated no relevant financial relationships.

Yi Tat Tong indicated no relevant financial relationships.

Dongfeng Tan indicated no relevant financial relationships.

Mehmet Altan: Adaptimmune – Grant/Research Support. Astra Zenecca – Speakers Bureau. Bristol Myers Squibb – Grant/Research Support. Eli Lilly – Grant/Research Support. genentech – Grant/Research Support. GlaxoSmithKline – Advisor or Review Panel Member, Grant/Research Support. Jounce therapeutics – Grant/Research Support. Merck – Grant/Research Support. Nektar Therapeutics – Advisor or Review Panel Member, Grant/Research Support. Novartis – Grant/Research Support. Shattuck Lab – Advisor or Review Panel Member, Grant/Research Support.

Bilal Siddiqui indicated no relevant financial relationships.

Anam Khan indicated no relevant financial relationships.

Anusha Thomas indicated no relevant financial relationships.

Yinghong Wang: AzurRx – Consultant. MabQuest – Advisory Committee/Board Member. Sorriso – Consultant. Tillotts – Consultant.

Austin R. Thomas, DO¹, Cynthia Liu, MD², Yi Tat Tong, DO³, Dongfeng Tan, MD⁴, Mehmet Altan, MD⁴, Bilal A. Siddiqui, MD⁵, Anam Khan, MD⁴, Anusha S. Thomas, MD⁴, Yinghong Wang, MD, PhD⁴. E0104 - Characteristics and Outcomes of Cancer Patients With Pre-existing Microscopic Colitis After Exposure to Immune Checkpoint Inhibitors, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.