Austin R Thomas1, Mostafa Eyada2, Anusha S Thomas2, Yinghong Wang3, Miho Kono2, Krishnavathana Varatharajalu2, Yang Lu4, Guofan Xu4, Kavea Panneerselvam5, Malek Shatila2, Mehmet Altan6, Jennifer Wang7, John A Thompson8, Hao Chi Zhang2, Muhammad Ali Khan2, Gottumukkala S Raju2. 1. Department of Internal Medicine, The University of Texas Health Science Center, Houston, TX, USA. 2. Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 3. Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. ywang59@mdanderson.org. 4. Division of Diagnostic Imaging, Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 5. Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA. 6. Department of Thoracic-Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 7. Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 8. Department of Medicine, University of Washington Member, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Abstract
PURPOSE: Immune checkpoint inhibitors (ICIs) are efficacious for treating various malignancies. In addition to immune-related adverse events (irAEs), growing evidence suggests that ICIs might also be associated with diverticulitis. We aim to assess the clinical presentations and management of colonic diverticulitis among cancer patients after ICI treatment. METHODS: A retrospective study was conducted on ICI-treated adult cancer patients between 01/2010 and 06/2020. Patients were grouped based on when diverticulitis developed relative to ICI treatment, either before (controls) or after (cases). Patient clinical characters, treatment, and outcomes were compared between both groups. RESULTS: 77 eligible patients were included: 63 patients developed diverticulitis after ICI exposure (46 had initial episode after ICI exposure, 17 had a history of diverticulitis prior then recurred after ICI exposure), and 14 had diverticulitis before ICI exposure. Diverticulitis occurred after a median of 129 days after ICI initiation. Clinical characteristics overlapped with traditional diverticulitis. 93% of patients had symptom resolution after treatment, while 23.8% experienced complications. These patients exhibited higher rates of hospitalization (87% vs 48%, P = 0.015) and surgery/interventional radiology procedures (27% vs 0, P = 0.002), and worse overall survival (P = 0.022). History of diverticulitis was not associated with a more severe disease course. Immunosuppressants (e.g., corticosteroids) were rarely required unless for concurrent ICI-mediated colitis. CONCLUSION: Colonic diverticulitis can occur after ICI therapy at very low incidence (0.5%). Its clinical presentation, evaluation, and management are similar to traditional diverticulitis, but associated with higher complication rates requiring surgical intervention and has lower overall survival.
PURPOSE: Immune checkpoint inhibitors (ICIs) are efficacious for treating various malignancies. In addition to immune-related adverse events (irAEs), growing evidence suggests that ICIs might also be associated with diverticulitis. We aim to assess the clinical presentations and management of colonic diverticulitis among cancer patients after ICI treatment. METHODS: A retrospective study was conducted on ICI-treated adult cancer patients between 01/2010 and 06/2020. Patients were grouped based on when diverticulitis developed relative to ICI treatment, either before (controls) or after (cases). Patient clinical characters, treatment, and outcomes were compared between both groups. RESULTS: 77 eligible patients were included: 63 patients developed diverticulitis after ICI exposure (46 had initial episode after ICI exposure, 17 had a history of diverticulitis prior then recurred after ICI exposure), and 14 had diverticulitis before ICI exposure. Diverticulitis occurred after a median of 129 days after ICI initiation. Clinical characteristics overlapped with traditional diverticulitis. 93% of patients had symptom resolution after treatment, while 23.8% experienced complications. These patients exhibited higher rates of hospitalization (87% vs 48%, P = 0.015) and surgery/interventional radiology procedures (27% vs 0, P = 0.002), and worse overall survival (P = 0.022). History of diverticulitis was not associated with a more severe disease course. Immunosuppressants (e.g., corticosteroids) were rarely required unless for concurrent ICI-mediated colitis. CONCLUSION: Colonic diverticulitis can occur after ICI therapy at very low incidence (0.5%). Its clinical presentation, evaluation, and management are similar to traditional diverticulitis, but associated with higher complication rates requiring surgical intervention and has lower overall survival.
Authors: Hamzah Abu-Sbeih; Faisal S Ali; Wei Qiao; Yang Lu; Sapna Patel; Adi Diab; Yinghong Wang Journal: Cancer Immunol Immunother Date: 2019-01-21 Impact factor: 6.968
Authors: Ellen J Beswick; Carl Grim; Abinav Singh; Jose E Aguirre; Marissa Tafoya; Suimin Qiu; Gerhard Rogler; Rohini McKee; Von Samedi; Thomas Y Ma; Victor E Reyes; Don W Powell; Irina V Pinchuk Journal: Front Immunol Date: 2018-05-30 Impact factor: 7.561
Authors: Anne Bertrand; Marie Kostine; Thomas Barnetche; Marie-Elise Truchetet; Thierry Schaeverbeke Journal: BMC Med Date: 2015-09-04 Impact factor: 8.775