Resumption of Immune Checkpoint Inhibitor Therapy After Immune-Mediated Colitis

ECU Author/Contributor (non-ECU co-authors, if there are any, appear on document)

Hamzah,Ali,Faisal S.,Patel,Sandipkumar,Otterson,Gregory A.,Kendra,Ka Abu-Sbeih (Creator)

Institution

East Carolina University (ECU )

Web Site: http://www.ecu.edu/lib/

Abstract: PURPOSE: Immune checkpoint inhibitor (ICI) therapy often is suspended because of immune-mediated diarrheaand colitis (IMDC). We examined the rate of and risk factors for IMDC recurrence after ICI resumption.METHODS: This retrospective multicenter study examined patients who resumed ICI therapy after improvement ofIMDC between January 2010 and November 2018. Univariable and multivariable logistic regression analysesassessed the association of clinical covariates and IMDC recurrence.RESULTS: Of the 167 patients in our analysis, 32 resumed an anti--cytotoxic T-cell lymphocyte-4 (CTLA-4) agent,and 135 an anti--programmed cell death 1 or ligand 1 (PD-1/L1) agent. The median age was 60 years(interquartile range [IQR], 50-69 years). The median duration from IMDC to restart of ICI treatment was 49 days(IQR, 23-136 days). IMDC recurred in 57 patients (34%) overall (44% of those receiving an anti--CTLA-4 and32% of those receiving an anti--PD-1/L1); 47 of these patients (82%) required immunosuppressive therapy forrecurrent IMDC, and all required permanent discontinuation of ICI therapy. The median duration from ICIresumption to IMDC recurrence was 53 days (IQR, 22-138 days). On multivariable logistic regression, patientswho received anti--PD-1/L1 therapy at initial IMDC had a higher risk of IMDC recurrence (odds ratio [OR], 3.45;95% CI, 1.59 to 7.69; P = .002). Risk of IMDC recurrence was higher for patients who required immunosuppression for initial IMDC (OR, 3.22; 95% CI, 1.08 to 9.62; P = .019) or had a longer duration of IMDCsymptoms in the initial episode (OR, 1.01; 95% CI, 1.00 to 1.03; P = .031). Risk of IMDC recurrence was lowerafter resumption of anti--PD-1/L1 therapy than after resumption of anti--CTLA-4 therapy (OR, 0.30; 95% CI, 0.11to 0.81; P = .019).CONCLUSION: One third of patients who resumed ICI treatment after IMDC experienced recurrent IMDC. Recurrence of IMDC was less frequent after resumption of anti--PD-1/L1 than after resumption of anti--CTLA-4

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Other

Language: English

Date: 2019

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