Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Oct 24, 2019; 10(10): 350-357
Published online Oct 24, 2019. doi: 10.5306/wjco.v10.i10.350
Vedolizumab in combined immune checkpoint therapy-induced infliximab-refractory colitis in a patient with metastatic melanoma: A case report
Manreet Randhawa, Gregory Gaughran, Christine Archer, Paul Pavli, Adrienne Morey, Sayed Ali, Desmond Yip
Manreet Randhawa, Gregory Gaughran, Christine Archer, Sayed Ali, Desmond Yip, Department of Medical Oncology, Canberra Region Cancer Centre, The Canberra Hospital, Canberra, ACT 2605, Australia
Paul Pavli, Department of Gastroenterology, The Canberra Hospital, Canberra, ACT 2605, Australia
Paul Pavli, Adrienne Morey, Sayed Ali, Desmond Yip, ANU Medical School, Australian National University, Canberra, ACT 2601, Australia
Adrienne Morey, Department of Anatomical Pathology, The Canberra Hospital, Canberra, ACT 2605, Australia
Author contributions: Randhawa M, Gaughran G and Archer C contributed equally to this work and wrote the paper; Randhawa M, Gaughran G, Archer C, Pavli P, Morey A, Ali S and Yip D were involved in care of this patient and review and revision of this paper.
Informed consent statement: Informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016) and the manuscript was prepared and revised according to the CARE Checklist (2016).
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/
Corresponding author: Desmond Yip, FRACP, MBBS, Clinical Director, Professor, Department of Medical Oncology, Canberra Region Cancer Centre, The Canberra Hospital, Yamba Drive, Garran, Canberra, ACT 2605, Australia. desmond.yip@act.gov.au
Telephone: +61-2-51242220 Fax: +61-2-51244266
Received: February 27, 2019
Peer-review started: February 27, 2019
First decision: April 11, 2019
Revised: July 22, 2019
Accepted: September 5, 2019
Article in press: September 5, 2019
Published online: October 24, 2019
Abstract
BACKGROUND

Dual checkpoint inhibition improves response rates in treatment naïve patients with metastatic melanoma compared to monotherapy. However, it confers a higher rate of toxicity, including immune-related colitis. Steroids may not resolve symptoms in all cases. The use of vedolizumab, a humanized monoclonal antibody against α4β7 integrin has proven effective in cases refractory to standard treatment.

CASE SUMMARY

We report the case of a 27-year-old female with Stage IVd metastatic melanoma treated with ipilimumab and nivolumab. She developed severe colitis refractory to methylprednisolone, infliximab and mycophenolate mofetil but responded to vedolizumab.

CONCLUSION

This case report supports vedolizumab use in severe immune related colitis refractory to standard immunosuppression.

Keywords: Ipilimumab, Nivolumab, Metastatic melanoma, Steroid-refractory colitis, Infliximab-refractory colitis, Vedolizumab, Case report

Core tip: Dual checkpoint inhibition improves response rates in treatment naïve patients with metastatic melanoma compared to monotherapy. However, it confers a higher rate of toxicity, including immune-related colitis. The use of vedolizumab, a humanized monoclonal antibody against α4β7 integrin has proven effective in cases refractory to standard treatment. This is a case report of a 27-year-old female with Stage IVd metastatic melanoma treated with ipilimumab and nivolumab. She developed severe colitis refractory to methylprednisolone, infliximab and mycophenolate mofetil but responded to vedolizumab. This supports its use in severe immune related colitis refractory to standard immunosuppression.