P537 Steroid use in patients with immune checkpoint inhibitor colitis
Crothers-Stomps, L.(1);Mohsen, W.(1);Kakkadasam Ramaswamy, P.(1);Mason, R.(2);Dzienis, M.(2);Edwards, J.(1);
(1)Gold Coast University Hospital, Gastroenterology, Gold Coast, Australia;(2)Gold Coast University Hospital, Oncology, Gold Coast, Australia;
Background
Immune checkpoint inhibitors (ICIs) encompass drugs targeting cytotoxic T-lymphocyte antigen-4 (CTLA-4), inhibitors of programmed cell death receptor-1 (PD-1), and inhibitors of programmed cell death ligand 1 (PD-L1) used for the treatment of cancer. Gastrointestinal side effects associated with ICI therapy are among the most common complications. This study aims to review steroid use in patients admitted with ICI colitis.
Methods
This was a retrospective review of patients in a tertiary center who received ICIs between January 2018 and December 2020 who required admission for the development of ICI colitis. Demographic data, previous and ongoing therapy, laboratory parameters, medical therapy and endoscopic findings were reviewed.
Results
Of the 545 patients who received ICIs, 4% (22) required admission with ICI colitis. Of those who developed ICI colitis 31.8% (7) were receiving combination ipilimumab and nivolumab, 31.8% (7) were receiving pembrolizumab, 27.3% (6) were receiving nivolumab, 4.5% (1) were receiving cemiplimab and 4.5% (1) were receiving ipilimumab.
The median age was 64.5 years (52-75) with the median CTCAE severity score of colitis being 3 (2-3) and the median CTCAE diarrhoea score being 3 (3). On admission, the median stool frequency was 6 (5-8), with median symptom duration of 7 (4-13) days, and median hospital stay of 3 (3-6) days. Laboratory markers were monitored during admission (Table 1).
72% (16) of patients were commenced on intravenous corticosteroid therapy whilst an inpatient, with 95% (21) being discharged on oral prednisolone. Median duration on oral steroid was 22 (8-35) weeks. 36% (8) had oral prednisolone ongoing at the end of the review period. 27% (6) died whilst still on a weaning prednisolone regimen.
Conclusion
Despite improvement of symptoms during hospital admission with corticosteroid therapy, the majority of patients admitted for ICI colitis required prolonged treatment with corticosteroids.