The characteristics of nivolumab-induced colitis: an evaluation of three cases and a literature review.

Abstract

BACKGROUND:

The use of immune-checkpoint inhibitors in cancer treatment has become increasingly common, resulting in an increase in the incidence of related side effects. Diarrhoea and colitis have been previously documented as gastrointestinal tract-related side effects of immune-checkpoint inhibitors. Although PD-1/PD-L1 inhibitors produce fewer side effects than CTLA-4 inhibitors, diarrhoea and colitis continue to be reported. However, little is known about the endoscopic features associated with PD-1/PD-L1 inhibitors. In this report, we describe three cases of colitis induced by a PD-1 inhibitor nivolumab. These cases showed endoscopic findings characteristic of ulcerative colitis (UC). Treatment was in accordance with UC therapy, which resulted in beneficial outcomes.

CASE PRESENTATION:

Three patients with lung cancer treated with nivolumab presented with diarrhoea with (case 2) or without haematochezia (cases 1 and 3). Treatment with nivolumab was ceased and colonoscopy was performed, revealing endoscopic features similar to those of UC. These patients were diagnosed with nivolumab-induced colitis. Case 1 was treated with mesalazine, whereas cases 2 and 3 were treated with corticosteroids. Subsequently, their symptoms improved.

CONCLUSIONS:

Nivolumab-induced colitis exhibited similar characteristics to UC. Treatment was similar to that for UC and was successful.

• Authors: Ryosuke Yamauchi, Toshihiro Araki, Keiichi Mitsuyama, Takaaki Tokito, Hidenobu Ishii, Shinichiro Yoshioka, Kotaro Kuwaki, Atsushi Mori, Tetsuhiro Yoshimura, Osamu Tsuruta, Takuji Torimura
• Journal: BMC gastroenterology (BMC Gastroenterol) Vol. 18 Issue 1 Pg. 135 (Aug 31 2018) ISSN: 1471-230X [Electronic] England
• PMID: 30170560 (Publication Type: Case Reports, Journal Article, Review)

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal
• Antibodies, Monoclonal
• Antineoplastic Agents
• Glucocorticoids
• PDCD1 protein, human
• Programmed Cell Death 1 Receptor
• Nivolumab
• Mesalamine
• Methylprednisolone

Topics

• Aged
• Anti-Inflammatory Agents, Non-Steroidal (therapeutic use)
• Antibodies, Monoclonal (adverse effects)
• Antineoplastic Agents (adverse effects)
• Colitis, Ulcerative (chemically induced, drug therapy, pathology)
• Diarrhea (chemically induced, drug therapy)
• Gastrointestinal Hemorrhage (chemically induced, drug therapy)
• Glucocorticoids (therapeutic use)
• Humans
• Male
• Mesalamine (therapeutic use)
• Methylprednisolone (therapeutic use)
• Middle Aged
• Nivolumab
• Programmed Cell Death 1 Receptor (antagonists & inhibitors)