1
|
Ma C, MacDonald JK, Nguyen TM, Vande Casteele N, Linggi B, Lefevre P, Wang Y, Feagan BG, Jairath V. Pharmacological Interventions for the Prevention and Treatment of Immune Checkpoint Inhibitor-Associated Enterocolitis: A Systematic Review. Dig Dis Sci 2022; 67:1128-1155. [PMID: 33770330 DOI: 10.1007/s10620-021-06948-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/08/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients treated with immune checkpoint inhibitors (ICIs) may develop ICI-associated enterocolitis, for which there is no approved treatment. AIMS We aimed to systematically review the efficacy and safety of medical interventions for the prevention and treatment of ICI-associated enterocolitis. METHODS MEDLINE, EMBASE, and the Cochrane Library were searched to identify randomized controlled trials (RCTs), cohort and case-control studies, and case series/reports, evaluating interventions (including corticosteroids, biologics, aminosalicylates, immunosuppressants, and fecal transplantation) for ICI-associated enterocolitis. Clinical, endoscopic, and histologic efficacy endpoints were evaluated. The Grading of Recommendations, Assessment, Development, and Evaluation criteria were used to assess overall quality of evidence. RESULTS A total of 160 studies (n = 1514) were included (one RCT, 3 retrospective cohort studies, 156 case reports/case series). Very low quality evidence from one RCT suggests budesonide is not effective for prevention of ICI-associated enterocolitis in ipilimumab-treated patients (relative risk 0.93 [95% confidence interval 0.56, 1.56]). Very low quality evidence suggests that corticosteroids, infliximab, and vedolizumab may be effective for treatment of ICI-associated enterocolitis by inducing clinical response and remission. No validated indices for measuring disease activity were used. Biologic treatment was used in 42% (641/1528) of patients, as reported in 97 studies. ICIs were discontinued in 65% (457/702) of patients, as reported in 63 studies. CONCLUSIONS Current treatment recommendations for ICI-associated enterocolitis are based on very low quality evidence, primarily from case reports and case series. Large-scale prospective cohort studies and RCTs are needed to develop prophylactic and therapeutic treatments to minimize interruption or discontinuation of oncological therapies.
Collapse
Affiliation(s)
- Christopher Ma
- Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
- Alimentiv Inc (Formerly Robarts Clinical Trials), 100 Dundas St, Suite #200, London, ON, N6A 5B6, Canada.
| | - John K MacDonald
- Alimentiv Inc (Formerly Robarts Clinical Trials), 100 Dundas St, Suite #200, London, ON, N6A 5B6, Canada
| | - Tran M Nguyen
- Alimentiv Inc (Formerly Robarts Clinical Trials), 100 Dundas St, Suite #200, London, ON, N6A 5B6, Canada
| | - Niels Vande Casteele
- Alimentiv Inc (Formerly Robarts Clinical Trials), 100 Dundas St, Suite #200, London, ON, N6A 5B6, Canada
- Division of Gastroenterology, University of California San Diego, 4350 Executive Drive, Suite 210, La Jolla, San Diego, CA, 92121, USA
| | - Bryan Linggi
- Alimentiv Inc (Formerly Robarts Clinical Trials), 100 Dundas St, Suite #200, London, ON, N6A 5B6, Canada
| | - Pavine Lefevre
- Alimentiv Inc (Formerly Robarts Clinical Trials), 100 Dundas St, Suite #200, London, ON, N6A 5B6, Canada
| | - Yinghong Wang
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Brian G Feagan
- Alimentiv Inc (Formerly Robarts Clinical Trials), 100 Dundas St, Suite #200, London, ON, N6A 5B6, Canada
- Departments of Medicine, Epidemiology, and Biostatistics, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Vipul Jairath
- Alimentiv Inc (Formerly Robarts Clinical Trials), 100 Dundas St, Suite #200, London, ON, N6A 5B6, Canada
- Departments of Medicine, Epidemiology, and Biostatistics, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada
| |
Collapse
|