Immune Checkpoint Inhibitors: Adverse Effects and Management
Adverse effects of immune checkpoint inhibitors, focusing on a case study of immune-mediated colitis in a 61-year-old woman undergoing combination ICI therapy. Covers investigations, management strategies, and clinical lessons for handling immune-related adverse events.
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Presentation Transcript
Adverse Effects of Immune Checkpoint Inhibitors: A Case of Immune-Mediated Colitis Dr. Amalia Stavropoulos (IMT1) Dr. Marios Decatris (Cons)
Case Presentation A 61-year-old woman with recurrent malignant melanoma Currently undergoing combination ICI-therapy: Ipilimumab Nivolumab History: Suffered several immune-mediated side effects Two recent admissions for Grade 2 ICI-mediated diarrhoea Presents with: 3-day history of 10 loose bowel motions daily
Management Grade Definition Management Symptomatic treatment (Loperamide, electrolyte replacement, oral fluids) Continue ICI therapy Grade 1 (Mild) < 4 liquid stools per day above baseline 4-6 liquid stools per day above baseline +/- blood or mucus in stool +/- abdominal pain +/- nocturnal symptoms Symptomatic treatment (as above) Oral corticosteroids Withhold ICI therapy Grade 2 (Moderate) Admission to hospital o IV Methylprednisolone (1-2 mg/kg once daily) 7 liquid stools per day above baseline Grade 3/ Grade 4 (Severe) Involve Gastroenterology o Sigmoidoscopy/colonoscopy o IV Infliximab (5 mg/kg) or Life threatening signs (peritoneal signs, fever, ileus, consistent with bowel perforation) Consider permanent discontinuation of ICI therapy
Management Clinical Lessons Immune-related adverse events (IRAEs) are common Treatment of immune-mediated colitis (IMC) consists of: supportive measures high dose corticosteroids Endoscopy should be considered in Grade 3/4 colitis. Refractory cases should be managed with: Infliximab Gastroenterology involvement An MDT-based approach is key to the best possible outcome in such cases
Acknowledgements I would like to thank: The Patient Dr M. Decatris Gastroenterology colleagues
