Outcomes of vedolizumab therapy in patients with immune checkpoint inhibitor-induced colitis: a multi-center study
Open accessAbstract
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 (interquartile range 1-4). The mean duration of follow-up was 15 months. Twenty-four patients (86%) achieved and sustained clinical remission. Repeat endoscopic evaluation was performed in 17 patients. Endoscopic remission was attained in 7 (54%) of the 13 patients who had abnormal endoscopic findings initially; 5/17 patients (29%) reached histologic remission as well. CONCLUSIONS: Vedolizumab can be appropriate for the treatment of steroid-refractory IMDC, with favorable outcomes and a good safety profile.
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Vedolizumab is an effective and well-tolerated therapeutic for steroid-dependent or refractory ICI-induced enterocolitis.
“Based on two retrospective series, VDZ is an effective and well-tolerated therapeutic for steroid-dependent or refractory ICI-induced enterocolitis.69,70”
From Autoimmune diseases and immune-checkpoint inhibitors for cancer therapy: Review of the literature and personalized risk-based prevention strategy (2020) · cites this paper as [70]
In refractory ICI-related colitis, patients not responding to infliximab had a clinical success rate of 67% compared with 95% for patients who did not receive infliximab.
“Interestingly, in refractory ICI-related colitis, patients not responding to infliximab had a clinical success rate of 67% compared with 95% for patients who did not receive infliximab.70”
From Autoimmune diseases and immune-checkpoint inhibitors for cancer therapy: Review of the literature and personalized risk-based prevention strategy (2020) · cites this paper as [70]
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- Authors
- Abu-Sbeih, H., Ali, F. S., Alsaadi, D., Jennings, J., Luo, W., Gong, Z., Richards, D. M., Charabaty, A., & Wang, Y.
- Affiliations
- The University of Texas MD Anderson Cancer Center (US)
- MedStar Georgetown University Hospital (US)
- Corresponding author
- Wang, Yinghong
- Venue
- Journal for ImmunoTherapy of Cancer
- Publisher
- BMJ
- Published
- 2018-12
- Volume
- 6
- Issue
- 1
- Pages
- 142-142
- ISSN
- 2051-1426 (ISSN-L)
- PMC
- PMC6280383
- OpenAlex
- W2903072327
- Cited by
- 215
- References
- 42
- Citations by year
- 2026: 14 · 2025: 26 · 2024: 30 · 2023: 24 · 2022: 32 · 2021: 31 · 2020: 30 · 2019: 27
- FWCI
- 8.27
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal for ImmunoTherapy of Cancer (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- University of Texas MD Anderson Cancer Center
- Topics
- Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Health Sciences › Medicine › Epidemiology › Microscopic Colitis
- Keywords
- vedolizumab, immune checkpoint inhibitor-induced colitis, immune checkpoint inhibitors, steroid-refractory colitis, infliximab, clinical remission, endoscopic remission, histological remission, microscopic colitis, mucosal ulceration
- MeSH terms
- Antineoplastic Agents, Immunological, Aged, Biopsy, Colitis, Colonoscopy, Female, Gastrointestinal Agents, Humans, Male, Middle Aged, Neoplasms, Retrospective Studies, Biomarkers, Treatment Outcome, Drug Resistance, Neoplasm, Antibodies, Monoclonal, Humanized
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