Outcomes of vedolizumab therapy in patients with immune checkpoint inhibitor–induced colitis: a multi-center study

作者：Hamzah Abu‐Sbeih, Faisal S. Ali, Dana Alsaadi, Joseph Jennings, Wenyi Luo, Zimu Gong, David M. Richards, Aline Charabaty, Yinghong Wang · 发表于：Journal for ImmunoTherapy of Cancer · 年份：2018 · DOI：10.1186/s40425-018-0461-4 · 被引用次数：213 · 研究领域：Cancer Immunotherapy and Biomarkers、Microscopic Colitis、Inflammatory Bowel Disease

BACKGROUND: Immune-mediated diarrhea and colitis (IMDC) can limit immune checkpoint inhibitors (ICIs) treatment, which is efficacious for advanced malignancies. Steroids and infliximab are commonly used to treat it. These agents induce systemic immunosuppression, with its associated morbidity. We assessed clinical outcomes of vedolizumab as an alternative treatment for IMDC. METHODS: We analyzed a retrospective case series of adults who had IMDC refractory to steroids and/or infliximab and received vedolizumab from 12/2016 through 04/2018. RESULTS: Twenty-eight patients were included. The median time from ICI therapy to IMDC onset was 10 weeks. Fifteen patients (54%) had grade 2 and 13 (46%) had grade 3 or 4 IMDC. Mucosal ulceration was present in 8 patients (29%), and nonulcerative inflammation was present in 13 (46%). All patients had features of active histologic inflammation; 14 (50%) had features of chronicity, and 10 (36%) had features of microscopic colitis concurrently. The mean duration of steroid therapy was 96 days (standard deviation 74 days). Nine patients received infliximab in addition to steroids and their IMDC was refractory to it. Among these, the duration of steroid use was 131 days compared with 85 days in patients who did not receive infliximab. Likewise, patients who failed infliximab before vedolizumab had a clinical success rate of 67% compared to 95% for patients that did not receive infliximab. The median number of vedolizumab infusions was 3 (interq...