P053 - IMMUNO-CHECKPOINT INHIBITORS INDUCED COLITIS TREATED WITH MESALAMINE
(Room Poster Hall)
19 Jan 18
5:30 PM
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7:00 PM
Tracks:
Clinical and Research Challenges
Background: Immuno-checkpoint inhibitors (ICI) are becoming an integral part of advanced cancer treatment. ICI-induced colitis (ICI-C) is one of the most common adverse events that is usually treated with steroids, infliximab or vedolizumab. All these agents are immune-suppressants that are associated with certain risks. We describe here an alternative treatment for ICI-C without diminishing ICI effect or causing toxicity. Case 1: A 73 year old male with prostate cancer since 2011, treated with Ipilimumab in 5/2017. He developed grade 3 diarrhea two weeks later. Colonoscopy was normal with biopsy showing acute colitis. High dose steroids gave partial response. He achieved steroid free remission after mesalamine treatment in four weeks and remained for four months. Repeat biopsy showed mild chronic active colitis. Case 2: A 60 year old male with prostate cancer since 2002, treated with Ipilimumab in 4/2017. He developed abdominal pain and grade 3 diarrhea six days after the 3rd dose. CT scan revealed enteritis. Colonoscopy was normal with biopsy revealing chronic active colitis. Mesalamine achieved immediate symptom relief in two days, which was stopped after two weeks when a new ICI induced hepatitis occurred that required a short course of Medrol. His colitis remains in clinical remission after four months. Case 3: A 42 year old male with sarcoma since 2016, developed grade 2 colitis after three cycles of durvalumab and tremelimumab in 12/2016. His symptoms improved with intermittent steroids, but repeatedly recurred. Colonoscopy showed linear and aphthae ulcers in TI and rectum with biopsy showing chronic active enteritis and colitis. Oral mesalamine and canasa suppositories achieved remission in few days. Repeat colonoscopy showed improvement. He remained in clinical remission on mesalamine for four months. Conclusion: Mesalamine is a promising alternative to treat ICI-C without counteracting the effect of ICI or causing additional significant toxicity.