Abstract
BackgroundThe use of immune-checkpoint inhibitors in cancer treatment has become increasingly common, resulting in an increase in the incidence of related side effects. Diarrhoea and colitis have been previously documented as gastrointestinal tract-related side effects of immune-checkpoint inhibitors. Although PD-1/PD-L1 inhibitors produce fewer side effects than CTLA-4 inhibitors, diarrhoea and colitis continue to be reported. However, little is known about the endoscopic features associated with PD-1/PD-L1 inhibitors. In this report, we describe three cases of colitis induced by a PD-1 inhibitor nivolumab. These cases showed endoscopic findings characteristic of ulcerative colitis (UC). Treatment was in accordance with UC therapy, which resulted in beneficial outcomes.Case presentationThree patients with lung cancer treated with nivolumab presented with diarrhoea with (case 2) or without haematochezia (cases 1 and 3). Treatment with nivolumab was ceased and colonoscopy was performed, revealing endoscopic features similar to those of UC. These patients were diagnosed with nivolumab-induced colitis. Case 1 was treated with mesalazine, whereas cases 2 and 3 were treated with corticosteroids. Subsequently, their symptoms improved.ConclusionsNivolumab-induced colitis exhibited similar characteristics to UC. Treatment was similar to that for UC and was successful.
Highlights
The use of immune-checkpoint inhibitors in cancer treatment has become increasingly common, resulting in an increase in the incidence of related side effects
Grade 3/4 colitis accounts for 1–3% among patients treated with PD-1/PD-L1 inhibitors compared to 7–9% among patients treated with CTLA-4 inhibitors. These findings suggest that colitis is less frequent during treatment with PD-1/PD-L1 inhibitors than during treatment with CTLA-4 inhibitors [3, 5, 6]
We describe three cases of anti-PD-1 antibody nivolumab cessation because of severe colitis and consider the clinical features of this condition
Summary
Immune-checkpoint inhibitors, such as anti CTLA-4 antibody, anti PD-1 antibody, and anti PD-L1 antibody, have been shown to extend the survival rate of cancer patients [1,2,3], and their clinical usage has increased rapidly. Case 2 reported grade 2 colitis and diarrhoea five times per day for 7 weeks after the administration. To clarify the similarity between their appearance, representative endoscopic and histological images of ulcerative colitis (UC) are presented in Fig. 1d and h. As a result, they were diagnosed with nivolumab-induced colitis. The diarrhoea and colitis gradually improved, prompting us to gradually reduce their corticosteroid treatment
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