Taking the bull by the horn: the frontline use of infliximab for the treatment of immune checkpoint inhibitor-induced enterocolitis

Immune checkpoint inhibitors which activate the host’s immune system to fight cancer have brought dramatic improvements to the overall survival of a growing number of deadly malignancies. Their use comes at the expense of often serious immune-related adverse events which consist of an off-target attack of the immune system on potentially any of the human body’s healthy organs. For lack of better-validated evidence, and regardless of the organ affected, clinicians often use the same immunosuppressive regimens consisting of high dose corticosteroids followed by the introduction of biologic agents such as the tumor-necrosis alpha inhibitor infliximab for corticosteroid-refractory toxicities. The article by Johnson et al. is timely in providing a more personalized approach for the management of immune-related toxicities affecting the lower digestive tract with many positive clinical outcomes associated with the upfront use of infliximab in association with corticosteroids. This commentary will provide a narrative summary of their findings in light of the current clinical knowledge relevant to the understanding of immune-related enterocolitis.