title: Ipilimumab associated colitis: an IpiColitis case series at MedStar Georgetown University Hospital.
abstract: Although ipilimumab has been shown to improve survival in patients with metastatic melanoma and cause regression of metastatic renal cell carcinoma, the associated immune-related toxicities are of concern. The resultant T cell activation by this monoclonal antibody causes an increased immune response, which has been associated with many immune-regulated adverse effects. One of the most concerning effects is the development of colitis. Upwards to 8% of patients have been reported to develop colitis, with 5% being severe (Grades 3-4). While initial treatment of such adverse effects is generally comprised of supportive and symptomatic treatment, more severe cases warrant the use of high dose steroids. Furthermore, use of anti-TNF agents is usually reserved for those cases that prove to be refractory to steroids. We describe a systematic case review of seven patients who developed gastrointestinal symptoms following initiation of ipilimumab immunotherapy, and present the steps in their evaluation, treatment and outcomes at our institution.
authors.affiliation: Pawan Rastogi, Department of Medicine, MedStar Georgetown University Hospital, Washington, DC 20007, United States.
authors.forename: Pawan
authors.initials: P
authors.lastname: Rastogi
authors.affiliation: Pawan Rastogi, Department of Medicine, MedStar Georgetown University Hospital, Washington, DC 20007, United States.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Sultan
authors.affiliation: Pawan Rastogi, Department of Medicine, MedStar Georgetown University Hospital, Washington, DC 20007, United States.
authors.forename: Aline J
authors.initials: AJ
authors.lastname: Charabaty
authors.affiliation: Pawan Rastogi, Department of Medicine, MedStar Georgetown University Hospital, Washington, DC 20007, United States.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Atkins
authors.affiliation: Pawan Rastogi, Department of Medicine, MedStar Georgetown University Hospital, Washington, DC 20007, United States.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Mattar
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D003092:Colitis / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D003113:Colonoscopy; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000074324:Ipilimumab; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000473:pathology; D008875:Middle Aged; D009669:Nose Neoplasms / Q000188:drug therapy* / Q000473:pathology; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D000074324:Ipilimumab; D013256:Steroids
keywords: Colitis; Immune-regulated adverse effects; Immunology; Infliximab; Ipilimumab