At the Advances in Inflammatory Bowel Diseases regional meeting on June 19, Dr Wang discussed the management of colitis among patients receiving immune checkpoint inhibitor therapy for cancer.

Yinghong Wang, MD, is an associate professor of gastroenterology, hepatology, and nutrition at the University of Texas MD Anderson Cancer Center in Houston, Texas.

TRANSCRIPT:

Moderator:  Welcome to another podcast from the Gastroenterology Learning Network and from Advances in Inflammatory Bowel Diseases. Dr. Yinghong Wang is going to recap her presentation from the AIBD regional meeting on the development of colitis in patients being treated for cancer with immunotherapy.

Dr. Yinghong Wang:  Hello, everyone. This is Dr. Yinghong Wang. I'm a gastroenterologist from University of Texas MD Anderson Cancer Center, and I gave a talk regarding the management of immune checkpoint inhibitor-related toxicities.

As we all know the Nobel Prize was granted to the discovery of the immune checkpoint mechanism about a couple of years ago that led to the discovery of a new family of cancer treatment called immune checkpoint inhibitors or immunotherapy.

With the wider use of this immunotherapy among different cancer types over the past decade, we start to see more and more of target effect of this immunotherapy to noncancer cells, and we call it toxicity. At the same time, we see the high efficacy of this medication to eradicate cancer.

The toxicity can involve almost every single organ in our body. Among them, the GI toxicity is the most common one recorded. The presentation can be very severe and leads to the typical symptoms of diarrhea, bleeding, abdominal pain, anemia, and fever. That can lead to frequent interruption of patient cancer treatment.

The management of these toxicities is very critical for our GI providers to help the patients resume their cancer treatment and achieve clinical remission, especially if they know that for patients who develop GI toxicities, that is a target marker that this cancer immunotherapy is more effective for their cancer long-term.

That involves both the evaluation and the treatment that we can provide. Early recognition and appropriate evaluation to confirm diagnosis is very critical for the providers to start the appropriate treatment. Evaluation will involve all the stool studies or endoscopy evaluations and histology.

The treatment methods are quite overlapping with what we do for inflammatory bowel disease management, because they are an overlapping condition that involve the inflammatory process in the gut.

The treatment mainly involves the immunosuppression by cortical steroids and then the biological agents like infliximab type, like TNF-alpha blockers, or α₄β₇ integrin blockers like vedolizumab, or even the newer agents like IL-12 and 23 blockers, or kinase inhibitors. Those are relatively limited data, but the signal is still pointing to a very promising result.

Also, I want to mention that for the patients who had inflammatory bowel disease and develop cancer, they can also receive this cancer immunotherapy. However, they are at higher risk of develop colitis flareup or exacerbation once the immunotherapy is started.

However, the recurrent rate is all acceptable as well, 42 percent, and is manageable by the immunosuppression. The outcome or efficacy of cancer treatment is very comparable to the non-IBD population. This is based on our multicenter study.

The last part I really want to emphasize is about the fecal transplant benefit for this particular indication of medication- refractory immunotherapy colitis. Based on this small study, small-scale case series, the fecal transplant has been shown to achieve more than 75% success rate in eradicating this colitis and enable patients to resume their cancer treatment.

There will be a prospective future clinical trial looking at the fecal transplant as a compassionate treatment or the front-line treatment in immunotherapy-induced colitis.

I hope this information will help you to understand these novel disease entities and be ready to start seeing these patients in your clinic and manage them comfortably.

Thank you very much.