Chronic gastrointestinal immune-related adverse events in patients exposed to immune checkpoint inhibitors.

Background and Aims: Immune checkpoint inhibitors (ICI) cause acute gastrointestinal (GI) immune-related adverse events (IrAEs). We aimed to report and describe chronic GI IrAEs.
Methods: We included consecutive patients addressed to a single center between October 2010 and March 2022 for endoscopic and/or histological GI inflammation persisting at least six months after the last dose of ICI.
Results: Among a total of 178 patients addressed for GI IrAE, 14 met the inclusion criteria (8 %). The median follow-up was 13 months after discontinuation of ICI. The most common symptom was watery diarrhea (54 %). Ten (77 %) patients had colonic involvement and three patients (21 %) had ileal involvement. Ten patients (77 %) had inflammatory lesions, two patients (15 %) had fistulas and one patient had (8 %) a stricture. All patients had lymphoplasmacytic infiltrate and basal plasmacytosis, and seven (54 %) had crypt distortions. Nine patients (69 %) received medical therapy, including five patients treated with vedolizumab, two patients (15 %) underwent intestinal resection. At the last follow-up, seven of the 13 patients were receiving maintenance therapy. Endoscopic lesions persisted one year after discontinuing ICI in 4/6 patients, and two years after discontinuation in 3/4 patients.
Conclusions: Chronic GI IrAEs exist after ICI use.
Competing Interests: Declaration of competing interest Marine Jeay: no conflict of interest. Franck Carbonnel: received board or lecture fees from Enterome, MSD, BMS, Janssen, Pfizer, Abbvie, MaaT pharma, Mayoly Spindler, Takeda, Pileje, Tillotts, Celltrion, Roche, Ferring. Caroline Robert: occasional consultant to Bristol Myers Squibb, Roche, Amgen, Novartis, Pierre Fabre, MSD, Sanofi, Biothera, CureVac, and Merck. Charlotte Mussini: no conflict of interest. Christophe Bellanger: received board or lecture fees from Janssen, Takeda, Tillotts. Antoine Meyer: no conflict of interest.
(Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)