1. Enterocolitis in Patients With Cancer After Antibody Blockade of Cytotoxic T-Lymphocyte–Associated Antigen 4
- Author
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Illouz, Frédéric, Wang, Daniel Y, Ye, Fei, Zhao, Shilin, Johnson, Douglas B, Gupta, A., De Felice, K. M., Loftus, E. V., Khanna, S., Beck, Kimberly E., Blansfield, Joseph A., Tran, Khoi Q., Feldman, Andrew L., Hughes, Marybeth S., Royal, Richard E., Kammula, Udai S., Topalian, Suzanne L., Sherry, Richard M., Kleiner, David, Quezado, Martha, Lowy, Israel, Yellin, Michael, Rosenberg, Steven A., Yang, James C., Michot, J. M., Bigenwald, C., Champiat, S., Collins, M., Carbonnel, Franck, Postel-Vinay, S., Berdelou, A., Varga, A., Bahleda, R., Hollebecque, A., Massard, C., Fuerea, A., Ribrag, V., Gazzah, A., Armand, J. P., Amellal, N., Angevin, E., Noel, N., Boutros, C., Mateus, C., Robert, C., Soria, J. C., Marabelle, A., Lambotte, O., Gonzalez, Raul S., Salaria, Safia N., Bohannon, Caitlin D., Huber, Aaron R., Feely, Michael M., Shi, Chanjuan, Marthey, L., Mussini, C., Nachury, M., Nancey, S., Grange, F., Zallot, C., Peyrin-Biroulet, L., Rahier, J. F., de Beauregard, M. Bourdier, Mortier, L., Coutzac, C., Soularue, E., Lanoy, E., Kapel, N., Planchard, D., Chaput, N., Benson, Al B., Ajani, Jaffer A., Catalano, Robert B., Engelking, Constance, Kornblau, Steven M., Martenson, James A., McCallum, Richard, Mitchell, Edith P., O'Dorisio, Thomas M., Vokes, Everett E., Wadler, Scott, Haanen, J B A G, Kerr, K M, Peters, S, Larkin, J, Jordan, K, Bergqvist, Viktoria, Hertervig, Erik, Gedeon, Peter, Kopljar, Marija, Griph, Håkan, Kinhult, Sara, Carneiro, Ana, Marsal, Jan, Hsieh, Amy Hsin Chieh, Ferman, Mutaz, Brown, Michael P., Andrews, Jane M., Trainer, Harris, Hulse, Paul, Higham, Claire E, Trainer, Peter, Lorigan, Paul, Hughes, Jing, Vudattu, Nalini, Sznol, Mario, Gettinger, Scott, Kluger, Harriet, Lupsa, Beatrice, and Herold, Kevan C
- Subjects
Male ,Skin Neoplasms ,Cytotoxic ,medicine.medical_treatment ,Autoimmunity ,Dermatitis ,Lymphocyte Activation ,Gastroenterology ,Immune-related adverse events ,T-Lymphocyte Subsets ,Adrenal Cortex Hormones ,80 and over ,Immune-checkpoint inhibitor induced enterocolitis ,Neoplasm Metastasis ,Melanoma ,Enterocolitis ,Membrane Glycoproteins ,Subcutaneous ,Vaccination ,Antibodies, Monoclonal ,programmed cell death protein 1 ,Kidney Neoplasms ,Neoplasm Proteins ,Oncology ,Disease Progression ,chemically induced ,Lung cancer ,Nivolumab ,gastroenteritis ,Type 1 ,medicine.medical_specialty ,Antineoplastic Agents ,chemistry ,Antigen ,Antigens, CD ,HLA-A2 Antigen ,Diabetes Mellitus ,Humans ,Tumour neoantigen ,Aged ,ResearchInstitutes_Networks_Beacons/mcrc ,Immunotherapy ,medicine.disease ,Peptide Fragments ,Immunology ,adverse effects ,gastrointestinal tract ,Peptides ,Immune checkpoint blockade ,Autoimmune ,Cancer Research ,colitis ,T-Lymphocytes ,Programmed Cell Death 1 Receptor ,administration & dosage ,Anti-CTLA-4 ,Hepatitis ,immunology ,Neoplasms ,Monoclonal ,CTLA-4 Antigen ,Manchester Cancer Research Centre ,Anti-PD-1 antibody ,Cytotoxic T-lymphocyte-associated antigen 4 ,Middle Aged ,CD ,Differentiation ,Female ,immunotherapy ,medicine.symptom ,Intravenous ,gp100 Melanoma Antigen ,medicine.drug ,Adult ,etiology ,Vitiligo ,chemical and pharmacologic phenomena ,Ipilimumab ,Cancer Vaccines ,Antibodies ,Autoimmune Diseases ,Injections ,Gastrointestinal Agents ,blood ,Internal medicine ,Immune Tolerance ,medicine ,Antigens ,Vedolizumab treatment against irAEs ,Carcinoma, Renal Cell ,Salvage Therapy ,therapy ,business.industry ,Cancer ,Antigens, Differentiation ,Infliximab ,therapeutic use ,physiology ,Neoplasm ,pathology ,business - Abstract
PurposeCytotoxic T-lymphocyte–associated antigen 4 (CTLA4) is an inhibitory receptor on T cells. Knocking out CTLA4 in mice causes lethal lymphoproliferation, and polymorphisms in human CTLA4 are associated with autoimmune disease. Trials of the anti-CTLA4 antibody ipilimumab (MDX-010) have resulted in durable cancer regression and immune-mediated toxicities. A report on the diagnosis, pathology, treatment, clinical outcome, and significance of the immune-mediated enterocolitis seen with ipilimumab is presented.Patients and MethodsWe treated 198 patients with metastatic melanoma (MM) or renal cell carcinoma (RCC) with ipilimumab.ResultsThe overall objective tumor response rate was 14%. We observed several immune mediated toxicities including dermatitis, enterocolitis, hypophysitis, uveitis, hepatitis, and nephritis. Enterocolitis, defined by grade 3/4 clinical presentation and/or biopsy documentation, was the most common major toxicity (21% of patients). It presented with diarrhea, and biopsies showed both neutrophilic and lymphocytic inflammation. Most patients who developed enterocolitis responded to high-dose systemic corticosteroids. There was no evidence that steroid administration affected tumor responses. Five patients developed perforation or required colectomy. Four other patients with steroid-refractory enterocolitis appeared to respond promptly to tumor necrosis factor alpha blockade with infliximab. Objective tumor response rates in patients with enterocolitis were 36% for MM and 35% for RCC, compared with 11% and 2% in patients without enterocolitis, respectively (P = .0065 for MM and P = .0016 for RCC).ConclusionCTLA4 seems to be a significant component of tolerance to tumor and in protection against immune mediated enterocolitis and these phenomena are significantly associated in cancer patients.
- Published
- 2006