Ipilimumab-associated colitis : A literature review and retrospective study of patients treated by ipilimumab for advanced melanoma who developed colitis as a secondary effect

Details

Supervisors

DEWIT, Olivier ; Baurain, Jean-François

Faculty

Faculté de médecine et médecine dentaire

Degree label

Master [180] en médecine

Abstract

Background and aims: Ipilimumab is a monoclonal antibody that targets cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4) and is used for treatment in advanced melanoma. However, it can induce immune-related adverse events, such as colitis. This study aims to define this type of colitis, identify its frequency and explore possible treatment options. Methods: A retrospective analysis was performed of 90 patients at St Luc all of whom received ipilimumab at 3mg/kg for advanced melanoma. Clinical, endoscopic, blood work-up, histological data and level of treatment was collected retroactively to classify these patients to find those that developed colitis. Results Of the 90 patients, 23 (25.6%) had varying degrees of diarrhoea-like symptoms. Amongst this subset of patients, 17 (18.9 %) developed colitis. All 17 of these patients, were clinically suspected as having ipilimumab-associated colitis and 7 of them required endoscopies. Only one patient showed evidence of this type colitis on histology which did not impact the patient care. Associated symptoms included pain (47%), vomiting (29.4%), haematochezia (23.5%), fatigue (29.4%) and fever (23.5%). In terms of treatment, all of the patients required corticoids. Two of them required escalation to methotrexate and 4 of them to infliximab. One of the patients, perforated and required surgery. Conclusion In this retrospective analysis, ipilimumab-associated colitis was confirmed as being a new entity, separate from other known forms of inflammatory bowel disease. The frequency (18.9%) of colitis in this study is comparable to that in literature. A more rigorous evaluation and treatment of diarrhoea before the next infusion of ipilimumab may help to avoid the worsening colitis and improve its management. The clinical evaluation for severity in conjunction of early endoscopy may help to qualify patients in need of recourse to methotrexate or infliximab.