Immune-Related Diarrhea and Colitis in Non-small Cell Lung Cancers: Impact of Multidisciplinary Management in a Real-World Setting

Author:

Bonanno Laura1ORCID,Lorenzi Martina12ORCID,Massa Davide12ORCID,De Nuzzo Mattia12ORCID,Angerilli Valentina3ORCID,Zingone Fabiana24ORCID,Barberio Brigida24ORCID,Russi Alberto5ORCID,Girardi Fabio1ORCID,Ferro Alessandra1ORCID,Dal Maso Alessandro1ORCID,Frega Stefano1ORCID,Pasello Giulia12ORCID,Dei Tos Angelo Paolo3,Coppola Marina5ORCID,Fassan Matteo36ORCID,Savarino Edoardo Vincenzo24,Guarneri Valentina12ORCID

Affiliation:

1. Oncology 2, Istituto Oncologico Veneto IOV IRCCS , Padova , Italy

2. Department of Surgery, Oncology and Gastroenterology, University of Padova , Padova , Italy

3. Department of Medicine (DIMED), Surgical Pathology Unit, University of Padova , Padova , Italy

4. Gastroenterology Unit, Azienda Ospedale Università of Padua , Padova , Italy

5. Pharmacy Unit, Istituto Oncologico Veneto IOV IRCCS , Padova , Italy

6. Istituto Oncologico Veneto IOV IRCCS , Padova , Italy

Abstract

Abstract Introduction Immune-related adverse events (irAEs) constitute a challenge in the clinical management of solid tumors. This study aims to collect real-world data on the occurrence of immune-mediated diarrhea and colitis (IMDC) in advanced non-small cell lung cancer (aNSCLC) treated with immune checkpoint inhibitors (ICIs) and to assess the clinical impact of a multidisciplinary approach (MDA) on IMDC management. Methods We retrospectively collected data on patients with aNSCLC consecutively treated with ICIs, either as single agent or in combination with chemotherapy, between September 2013 and July 2022. Among patients developing IMDC, we conducted blinded revision of colonic biopsies and evaluated the clinical impact of the introduction of MDA through predefined indicators. Results Among the 607 patients included, 84 (13.8%) experienced IMDC. Pathological review highlighted a high prevalence of microscopic colitis (28%), with a collagenous pattern linked to longer symptoms duration (P = .01). IMDC occurred more frequently in females (P = .05) and PD-L1 expressors (P = .014) and was correlated with longer progression-free survival (17.0 vs 5.8, P < .001) and overall survival (28.3 vs 9.5, P < .001). The introduction of MDA was associated with increased employment of diagnostical tools such as fecal calprotectin test (P < .001), colonoscopy (P < .001), and gastroenterological evaluation (P = .017) and a significant decrease in both grade 3 conversion rate (P = .046) and recurrence after rechallenge (P = .016). Hospitalization rate dropped from 17.2% to 3.8% (P: ns). Conclusion These findings highlight the clinical relevance of IMDC and support the incorporation of a MDA to optimize the clinical management of this irAE to improve patient care. Prospective validation has been planned.

Funder

Italian Ministry of Health

Publisher

Oxford University Press (OUP)

Subject

Cancer Research,Oncology

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