Immune checkpoint inhibitor-related colitis assessment and prognosis: can IBD scoring point the way?



Cheung, Vincent Ting Fung, Gupta, Tarun, Olsson-Brown, Anna, Subramanian, Sreedhar ORCID: 0000-0002-6483-1730, Sasson, Sarah Christina, Heseltine, Jonathan, Fryer, Eve, Collantes, Elena, Sacco, Joseph J, Pirmohamed, Munir ORCID: 0000-0002-7534-7266
et al (show 9 more authors) (2020) Immune checkpoint inhibitor-related colitis assessment and prognosis: can IBD scoring point the way? BRITISH JOURNAL OF CANCER, 123 (2). pp. 207-215.

Access the full-text of this item by clicking on the Open Access link.

Abstract

<h4>Background</h4>Immune checkpoint inhibitors (ICI) improve survival but cause immune-related adverse events (irAE). We sought to determine if CTCAE classification, IBD biomarkers/endoscopic/histological scores correlate with irAE colitis outcomes.<h4>Methods</h4>A dual-centre retrospective study was performed on patients receiving ICI for melanoma, NSCLC or urothelial cancer from 2012 to 2018. Demographics, clinical data, endoscopies (reanalysed using Mayo/Ulcerative Colitis Endoscopic Index of Severity (UCEIS) scores), histology (scored with Nancy Index) and treatment outcomes were analysed.<h4>Results</h4>In all, 1074 patients were analysed. Twelve percent (134) developed irAE colitis. Median patient age was 66, 59% were male. CTCAE diarrhoea grade does not correlate with steroid/ infliximab use. G3/4 colitis patients are more likely to need infliximab (p < 0.0001) but colitis grade does not correlate with steroid duration. CRP, albumin and haemoglobin do not correlate with severity. The UCEIS (p = 0.008) and Mayo (p = 0.016) scores correlate with severity/infliximab requirement. Patients with higher Nancy indices (3/4) are more likely to require infliximab (p = 0.03).<h4>Conclusions</h4>CTCAE assessment does not accurately reflect colitis severity and our data do not support its use in isolation, as this may negatively impact timely management. Our data support utilising endoscopic scoring for patients with >grade 1 CTCAE disease, and demonstrate the potential prognostic utility of objective histologic scoring.

Item Type: Article
Uncontrolled Keywords: Urothelium, Humans, Melanoma, Carcinoma, Non-Small-Cell Lung, Colitis, Colonoscopy, Prognosis, Treatment Outcome, Severity of Illness Index, Aged, Middle Aged, Female, Male, Drug-Related Side Effects and Adverse Reactions, Infliximab, Immune Checkpoint Inhibitors
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology
Depositing User: Symplectic Admin
Date Deposited: 26 Jun 2020 10:12
Last Modified: 18 Jan 2023 23:49
DOI: 10.1038/s41416-020-0882-y
Open Access URL: http://doi.org/10.1038/s41416-020-0882-y
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3090399