P016 - CASE SERIES: IMMUNOTHERAPY-INDUCED LYMPHOCYTIC COLITIS
(Room Poster Hall)
19 Jan 18
5:30 PM
-
7:00 PM
Tracks:
Clinical and Research Challenges
Background: Immunotherapy enhances T cell’s action on tumor cells by inhibiting T cell inactivation. However, upregulation of T cells can lead to immunotherapy-induced colitis in which lymphocytic colitis (LC) pattern has been less frequently described. We present three cases of immunotherapy-induced LC with varying clinical presentations, disease courses and treatment regimens. Case 1: 51 y/o man with metastatic urothelial bladder carcinoma developed grade 2 diarrhea after his 6th cycle of atezolizumab. He had a normal colonoscopy with biopsy revealing LC compatible with immunotherapy-induced colitis. He received IV methylprednisolone and a total of four doses of infliximab with improvement. Case 2: 64 y/o man with metastatic renal cell carcinoma was hospitalized for grade 3 diarrhea after his 2nd cycle of nivolumab. Colonoscopy showed diffuse mild congestion and biopsy revealed LC. Diarrhea improved on oral methylprednisolone and resolved after two doses of vedolizumab. Case 3: 69 y/o man with metastatic prostate cancer was hospitalized for grade 3 diarrhea after his 4th cycle of ipilimumab. He had a normal colonoscopy with biopsy showing immunotherapy-induced LC. Diarrhea failed to improve on IV methylprednisolone, instead required two doses of infliximab with symptoms resolution. Conclusion: Microscopic colitis is thought to develop after an abnormal mucosal immune response. Therefore, it is not surprising that it can develop after immunotherapy given the immune dysregulation. This case series highlight the varying clinical presentations, disease courses and treatment strategies of immunotherapy-induced LC. Current management for immunotherapy-induced colitis is rudimentary at best with limited data on steroid type and dose, number of infliximab doses before switching to another agent, and the next line biological therapy. This case series also emphasize the need for further research in developing a comprehensive treatment algorithm.