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Immune checkpoint inhibitor-related colitis assessment and prognosis: can IBD scoring point the way?

BACKGROUND: Immune checkpoint inhibitors (ICI) improve survival but cause immune-related adverse events (irAE). We sought to determine if CTCAE classification, IBD biomarkers/endoscopic/histological scores correlate with irAE colitis outcomes. METHODS: A dual-centre retrospective study was performed...

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Autores principales: Cheung, Vincent Ting Fung, Gupta, Tarun, Olsson-Brown, Anna, Subramanian, Sreedhar, Sasson, Sarah Christina, Heseltine, Jonathan, Fryer, Eve, Collantes, Elena, Sacco, Joseph J., Pirmohamed, Munir, Simmons, Alison, Klenerman, Paul, Tuthill, Mark, Protheroe, Andrew S., Chitnis, Meenali, Fairfax, Benjamin Peter, Payne, Miranda Jane, Middleton, Mark Ross, Brain, Oliver
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7374736/
https://www.ncbi.nlm.nih.gov/pubmed/32418993
http://dx.doi.org/10.1038/s41416-020-0882-y
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author Cheung, Vincent Ting Fung
Gupta, Tarun
Olsson-Brown, Anna
Subramanian, Sreedhar
Sasson, Sarah Christina
Heseltine, Jonathan
Fryer, Eve
Collantes, Elena
Sacco, Joseph J.
Pirmohamed, Munir
Simmons, Alison
Klenerman, Paul
Tuthill, Mark
Protheroe, Andrew S.
Chitnis, Meenali
Fairfax, Benjamin Peter
Payne, Miranda Jane
Middleton, Mark Ross
Brain, Oliver
author_facet Cheung, Vincent Ting Fung
Gupta, Tarun
Olsson-Brown, Anna
Subramanian, Sreedhar
Sasson, Sarah Christina
Heseltine, Jonathan
Fryer, Eve
Collantes, Elena
Sacco, Joseph J.
Pirmohamed, Munir
Simmons, Alison
Klenerman, Paul
Tuthill, Mark
Protheroe, Andrew S.
Chitnis, Meenali
Fairfax, Benjamin Peter
Payne, Miranda Jane
Middleton, Mark Ross
Brain, Oliver
author_sort Cheung, Vincent Ting Fung
collection PubMed
description BACKGROUND: Immune checkpoint inhibitors (ICI) improve survival but cause immune-related adverse events (irAE). We sought to determine if CTCAE classification, IBD biomarkers/endoscopic/histological scores correlate with irAE colitis outcomes. METHODS: A dual-centre retrospective study was performed on patients receiving ICI for melanoma, NSCLC or urothelial cancer from 2012 to 2018. Demographics, clinical data, endoscopies (reanalysed using Mayo/Ulcerative Colitis Endoscopic Index of Severity (UCEIS) scores), histology (scored with Nancy Index) and treatment outcomes were analysed. RESULTS: In all, 1074 patients were analysed. Twelve percent (134) developed irAE colitis. Median patient age was 66, 59% were male. CTCAE diarrhoea grade does not correlate with steroid/ infliximab use. G3/4 colitis patients are more likely to need infliximab (p < 0.0001) but colitis grade does not correlate with steroid duration. CRP, albumin and haemoglobin do not correlate with severity. The UCEIS (p = 0.008) and Mayo (p = 0.016) scores correlate with severity/infliximab requirement. Patients with higher Nancy indices (3/4) are more likely to require infliximab (p = 0.03). CONCLUSIONS: CTCAE assessment does not accurately reflect colitis severity and our data do not support its use in isolation, as this may negatively impact timely management. Our data support utilising endoscopic scoring for patients with >grade 1 CTCAE disease, and demonstrate the potential prognostic utility of objective histologic scoring.
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spelling pubmed-73747362020-07-24 Immune checkpoint inhibitor-related colitis assessment and prognosis: can IBD scoring point the way? Cheung, Vincent Ting Fung Gupta, Tarun Olsson-Brown, Anna Subramanian, Sreedhar Sasson, Sarah Christina Heseltine, Jonathan Fryer, Eve Collantes, Elena Sacco, Joseph J. Pirmohamed, Munir Simmons, Alison Klenerman, Paul Tuthill, Mark Protheroe, Andrew S. Chitnis, Meenali Fairfax, Benjamin Peter Payne, Miranda Jane Middleton, Mark Ross Brain, Oliver Br J Cancer Article BACKGROUND: Immune checkpoint inhibitors (ICI) improve survival but cause immune-related adverse events (irAE). We sought to determine if CTCAE classification, IBD biomarkers/endoscopic/histological scores correlate with irAE colitis outcomes. METHODS: A dual-centre retrospective study was performed on patients receiving ICI for melanoma, NSCLC or urothelial cancer from 2012 to 2018. Demographics, clinical data, endoscopies (reanalysed using Mayo/Ulcerative Colitis Endoscopic Index of Severity (UCEIS) scores), histology (scored with Nancy Index) and treatment outcomes were analysed. RESULTS: In all, 1074 patients were analysed. Twelve percent (134) developed irAE colitis. Median patient age was 66, 59% were male. CTCAE diarrhoea grade does not correlate with steroid/ infliximab use. G3/4 colitis patients are more likely to need infliximab (p < 0.0001) but colitis grade does not correlate with steroid duration. CRP, albumin and haemoglobin do not correlate with severity. The UCEIS (p = 0.008) and Mayo (p = 0.016) scores correlate with severity/infliximab requirement. Patients with higher Nancy indices (3/4) are more likely to require infliximab (p = 0.03). CONCLUSIONS: CTCAE assessment does not accurately reflect colitis severity and our data do not support its use in isolation, as this may negatively impact timely management. Our data support utilising endoscopic scoring for patients with >grade 1 CTCAE disease, and demonstrate the potential prognostic utility of objective histologic scoring. Nature Publishing Group UK 2020-05-18 2020-07-21 /pmc/articles/PMC7374736/ /pubmed/32418993 http://dx.doi.org/10.1038/s41416-020-0882-y Text en © The Author(s) 2020 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Cheung, Vincent Ting Fung
Gupta, Tarun
Olsson-Brown, Anna
Subramanian, Sreedhar
Sasson, Sarah Christina
Heseltine, Jonathan
Fryer, Eve
Collantes, Elena
Sacco, Joseph J.
Pirmohamed, Munir
Simmons, Alison
Klenerman, Paul
Tuthill, Mark
Protheroe, Andrew S.
Chitnis, Meenali
Fairfax, Benjamin Peter
Payne, Miranda Jane
Middleton, Mark Ross
Brain, Oliver
Immune checkpoint inhibitor-related colitis assessment and prognosis: can IBD scoring point the way?
title Immune checkpoint inhibitor-related colitis assessment and prognosis: can IBD scoring point the way?
title_full Immune checkpoint inhibitor-related colitis assessment and prognosis: can IBD scoring point the way?
title_fullStr Immune checkpoint inhibitor-related colitis assessment and prognosis: can IBD scoring point the way?
title_full_unstemmed Immune checkpoint inhibitor-related colitis assessment and prognosis: can IBD scoring point the way?
title_short Immune checkpoint inhibitor-related colitis assessment and prognosis: can IBD scoring point the way?
title_sort immune checkpoint inhibitor-related colitis assessment and prognosis: can ibd scoring point the way?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7374736/
https://www.ncbi.nlm.nih.gov/pubmed/32418993
http://dx.doi.org/10.1038/s41416-020-0882-y
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