Rastogi P, Sultan M, Charabaty AJ, Atkins MB, Mattar MC. Ipilimumab associated colitis: An IpiColitis case series at MedStar Georgetown University Hospital. World J Gastroenterol 2015; 21(14): 4373-4378 [PMID: 25892889 DOI: 10.3748/wjg.v21.i14.4373]
Corresponding Author of This Article
Mark C Mattar, MD, Department of Gastroenterology, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Main Building Second Floor, Washington, DC 20007, United States. mark.c.mattar@gunet.georgetown.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Apr 14, 2015; 21(14): 4373-4378 Published online Apr 14, 2015. doi: 10.3748/wjg.v21.i14.4373
Ipilimumab associated colitis: An IpiColitis case series at MedStar Georgetown University Hospital
Pawan Rastogi, Mohamed Sultan, Aline J Charabaty, Michael B Atkins, Mark C Mattar
Pawan Rastogi, Department of Medicine, MedStar Georgetown University Hospital, Washington, DC 20007, United States
Mohamed Sultan, Aline J Charabaty, Mark C Mattar, Department of Gastroenterology, MedStar Georgetown University Hospital, Washington, DC 2007, United States
Michael B Atkins, Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC 20007, United States
Author contributions: Rastogi P reviewed cases, collected data, and wrote the manuscript and references; Sultan M formatted images and provided revisions to the manuscript; Mattar MC is the author guarantor, supervised the process, and made revisions to the manuscript; Charabaty AJ and Atkins MB provided invaluable support and revision to the manuscript; Procedures were conducted by physicians of the Department of Gastroenterology and Hepatology at MedStar Georgetown University Hospital.
Supported by MedStar Georgetown University Hospital, Washington, DC, United States.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mark C Mattar, MD, Department of Gastroenterology, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Main Building Second Floor, Washington, DC 20007, United States. mark.c.mattar@gunet.georgetown.edu
Telephone: +1-202-4441031 Fax: +1-877-3031462
Received: August 19, 2014 Peer-review started: August 20, 2014 First decision: September 27, 2014 Revised: October 22, 2014 Accepted: December 16, 2014 Article in press: December 16, 2014 Published online: April 14, 2015
Abstract
Although ipilimumab has been shown to improve survival in patients with metastatic melanoma and cause regression of metastatic renal cell carcinoma, the associated immune-related toxicities are of concern. The resultant T cell activation by this monoclonal antibody causes an increased immune response, which has been associated with many immune-regulated adverse effects. One of the most concerning effects is the development of colitis. Upwards to 8% of patients have been reported to develop colitis, with 5% being severe (Grades 3-4). While initial treatment of such adverse effects is generally comprised of supportive and symptomatic treatment, more severe cases warrant the use of high dose steroids. Furthermore, use of anti-TNF agents is usually reserved for those cases that prove to be refractory to steroids. We describe a systematic case review of seven patients who developed gastrointestinal symptoms following initiation of ipilimumab immunotherapy, and present the steps in their evaluation, treatment and outcomes at our institution.
Core tip: The development of colitis in the setting of ipilimumab use has become of great concern. Treatment regimens, predictive factors, and prognostic indicators have yet to become standardized and elucidated. Here we present one of the largest case series of ipilimumab associated colitis at a single tertiary care institution, as well as our approach to evaluating and treating suspected cases.
