P052 - IMMUNO-CHECKPOINT INHIBITOR INDUCED COLITIS IN A PATIENT WITH LUNG CANCER AND COLON METASTASIS TREATED WITH MESALAMINE: A CASE STUDY
(Room Poster Hall)
19 Jan 18
5:30 PM
-
7:00 PM
Tracks:
Clinical and Research Challenges
Background: Immuno-checkpoint inhibitor (ICI) is becoming an integral part of advanced cancer treatment. ICI can cause adverse events in multiple organs more commonly in skin and GI tract. ICI-induced colitis (ICI-C) can be mild or severe and lead to cessation of cancer treatment. There is insufficient information about the optimal treatment for ICI-C. Based on published case series, ICI-C can improve with high dose steroids as first line and infliximab or vedolizumab as second line treatment. Here, we describe an alternative promising treatment for ICI-C resulted in an excellent outcome. Case report: A 69 year old male patient was diagnosed with stage IB lung adenocarcinoma in 2012. He went into remission for 2 years after right upper lobectomy. In 1/2014, he developed metastatic pleural nodule and started treatment with chemotherapeutic agents. He had disease progression in 9/2015 and was switched to nivolumab for 2 years. In 8/2017, he presented with 2-3 loose BM a day (grade 1), severe abdominal pain and 20LB weight loss. Colonoscopy was normal except 2 masses in the ascending colon, which was proven to be metastatic lung adenocarcinoma. Biopsies from the rest of the colon demonstrated pathological features of ICI-C. Given the complicated and contradictory scenario of tumor progression to the colon and ICI-C, treatment options became very limited. On one hand, the colon is not benefiting from ICI as evidenced by new metastatic lesions, at the same time, it got inflammatory toxicity from ICI. We started him on 4.8g mesalamine daily. He achieved resolution of abdominal pain in 3 days and normal bowel movement in 7 days. The patient stays in remission on 4 weeks follow up. Conclusion: Our treatment goal is to minimize systemic immunosuppressant use for ICI-C to achieve maximal efficacy of ICI without additional toxicities. In this dilemma, mesalamine can be a very effective treatment option for selected patients.