Rubin SJS, Balabanis T, Gubatan J, Habtezion A. Disease exacerbation is common in inflammatory bowel disease patients treated with immune checkpoint inhibitors for malignancy. World J Clin Cases 2022; 10(6): 1787-1794 [PMID: 35317167 DOI: 10.12998/wjcc.v10.i6.1787]
Corresponding Author of This Article
Samuel J S Rubin, PhD, Postdoctoral Fellow, Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Alway Building, Room M211, 300 Pasteur Drive, Stanford, CA 94305, United States. yrubin@stanford.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
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Rubin SJS, Balabanis T, Gubatan J, Habtezion A. Disease exacerbation is common in inflammatory bowel disease patients treated with immune checkpoint inhibitors for malignancy. World J Clin Cases 2022; 10(6): 1787-1794 [PMID: 35317167 DOI: 10.12998/wjcc.v10.i6.1787]
World J Clin Cases. Feb 26, 2022; 10(6): 1787-1794 Published online Feb 26, 2022. doi: 10.12998/wjcc.v10.i6.1787
Disease exacerbation is common in inflammatory bowel disease patients treated with immune checkpoint inhibitors for malignancy
Aida Habtezion, John Gubatan, Tatiana Balabanis, Samuel J S Rubin
Samuel J S Rubin, Tatiana Balabanis, John Gubatan, Aida Habtezion, Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, United States
Author contributions: Rubin SJS, Gubatan J and Habtezion A helped plan the study, interpret data, and draft the manuscript. Rubin SJS, Balabanis T, Gubatan J and Habtezion A interpreted data; Balabanis T collected data; all authors approved the final draft submitted.
Supported bythe Stanford Medical Scholars Fellowship Program to Rubin SJS.
Institutional review board statement: The study is approved by the Stanford Institutional Review Board (57160).
Informed consent statement: Because of the retrospective and anonymous character of this study, the need for informed consent was waived by the institutional review board.
Conflict-of-interest statement: All authors declare no conflicts of interest.
Data sharing statement: The full data underlying this article cannot be shared publicly due to privacy of the individuals that participated in the study. The de-identified data will be shared on reasonable request to the corresponding authors.
STROBE statement: Authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Corresponding author: Samuel J S Rubin, PhD, Postdoctoral Fellow, Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Alway Building, Room M211, 300 Pasteur Drive, Stanford, CA 94305, United States. yrubin@stanford.edu
Received: May 28, 2021 Peer-review started: June 1, 2021 First decision: July 14, 2021 Revised: July 19, 2021 Accepted: January 11, 2022 Article in press: January 11, 2022 Published online: February 26, 2022 Processing time: 270 Days and 16.6 Hours
Abstract
BACKGROUND
Colitis is a known potential toxicity of immune checkpoint inhibitors (ICIs). Studies evaluating the risk of disease exacerbation following ICI treatment in patients with pre-existing inflammatory bowel disease (IBD) are limited.
AIM
To assess the clinical characteristics of IBD patients treated with ICIs and determine prevalence of subsequent IBD exacerbations.
METHODS
We conducted a retrospective cohort study of all patients in the Stanford Research Repository database with pre-existing IBD who were exposed to ICIs.
RESULTS
The prevalence of IBD exacerbation following ICI was 36.8% amongst 19 patients meeting inclusion criteria. Patients with exacerbations had more gastrointestinal-related hospitalizations (4 of 7) than patients without exacerbations (0 of 12; P = 0.0090).
CONCLUSION
The prevalence of IBD exacerbations following ICI was higher than reported rates of ICI-induced colitis and diarrhea in the general population and was associated with hospitalization.
Core Tip: Immune checkpoint inhibitor (ICI)-mediated colitis is increasingly recognized as a complication of ICI therapy. The clinical outcomes of ICI therapy on underlying inflammatory bowel disease (IBD) in patients with malignancy is poorly understood. In this retrospective cohort study of IBD patients treated with ICIs for malignancy, we demonstrate that the prevalence of IBD exacerbation following ICI therapy was higher than reported ICI-induced colitis and diarrhea in the general population. ICI use among patients with IBD who had a disease exacerbation was also associated with increased rates of hospitalization.
