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

Author:

Cheung Vincent Ting FungORCID,Gupta Tarun,Olsson-Brown Anna,Subramanian Sreedhar,Sasson Sarah Christina,Heseltine Jonathan,Fryer Eve,Collantes Elena,Sacco Joseph J.,Pirmohamed Munir,Simmons Alison,Klenerman Paul,Tuthill Mark,Protheroe Andrew S.,Chitnis Meenali,Fairfax Benjamin Peter,Payne Miranda Jane,Middleton Mark Ross,Brain Oliver

Abstract

Abstract Background 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. Methods 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. Results 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). Conclusions 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.

Funder

Norman Collisson Foundation

Lee Placito Fellowship

RCUK | Medical Research Council

Celgene

Wellcome Trust

Publisher

Springer Science and Business Media LLC

Subject

Cancer Research,Oncology

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