Immune-related colitis – an issue in cancer patients

Irish Society of Gastroenterology, Winter Meeting, virtual, 2-3 December 2021

While immunotherapy has been a game changer in many different types of cancer, it comes at a cost of increased risk of immune-related complications in other organ systems, such as immunotherapy-induced colitis, the Irish Society of Gastroenterology 2021 Winter Meeting heard.

Dr Nick Powell, Consultant Gastroenterologist and Clinical Reader in Gastroenterology Imperial College London, said this is a growing issue that needs to be appropriately managed to ensure cancer patients achieve optimum outcomes and quality-of-life.

It is well known that chemotherapy causes diarrhoea and radiotherapy can cause pelvic area complications (proctitis, enteritis, etc) in cancer patients but newer agents, such as immune checkpoint inhibitors (CPI), are also causing issues, according to Dr Powell, who runs a special clinic with his oncology colleagues for these patients.

He quoted research showing the implications of CPI-related colitis development as being the most common reason for hospitalisation, treatment discontinuation, and treatment-related death (usually colonic perforation, in up to 5 per cent of these patients).

In relation to grading the severity of CPI-induced diarrhoea, Dr Powell discussed using the National Cancer Institute’s ‘common terminology criteria for adverse events’ scoring system, which has five grades of severity, noting that it has
no correlation with mucosal injury.

In terms of treatment and investigation, the British Society of Gastroenterology published new guidance last year, which was developed by a multidisciplinary group of gastroenterologists, oncologists, histopathologists, specialist nurses, dietitians, and patients. The US has also recently published guidance.

“In terms of investigation I think it is very important to achieve tissue diagnosis, to make sure we are treating the right
problem,” Dr Powell said.