Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2015 Apr 14;21(14):4373-8.
doi: 10.3748/wjg.v21.i14.4373.

Ipilimumab associated colitis: an IpiColitis case series at MedStar Georgetown University Hospital

Pawan Rastogi  1 , Mohamed Sultan  1 , Aline J Charabaty  1 , Michael B Atkins  1 , Mark C Mattar  1
Affiliations
Case Reports

Ipilimumab associated colitis: an IpiColitis case series at MedStar Georgetown University Hospital

Pawan Rastogi et al. World J Gastroenterol. .

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.

Keywords: Colitis; Immune-regulated adverse effects; Immunology; Infliximab; Ipilimumab.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Erythematous mucosa, loss of normal vascular pattern, multiple ulcers most consistent with IpiColitis.
Figure 2
Figure 2
Normal colonoscopy.
Figure 3
Figure 3
Erythema with ulceration and loss of vascular pattern.
Figure 4
Figure 4
Graph demonstrating normalization of C-reactive protein levels after treatment in two of the seven cases. CRP: C-reactive protein.
See this image and copyright information in PMC

References

    1. Hodi FS, O’Day SJ, McDermott DF, Weber RW, Sosman JA, Haanen JB, Gonzalez R, Robert C, Schadendorf D, Hassel JC, et al. Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med. 2010;363:711–723. - PMC - PubMed
    1. Yang JC, Hughes M, Kammula U, Royal R, Sherry RM, Topalian SL, Suri KB, Levy C, Allen T, Mavroukakis S, et al. Ipilimumab (anti-CTLA4 antibody) causes regression of metastatic renal cell cancer associated with enteritis and hypophysitis. J Immunother. 2007;30:825–830. - PMC - PubMed
    1. Hanaizi Z, van Zwieten-Boot B, Calvo G, Lopez AS, van Dartel M, Camarero J, Abadie E, Pignatti F. The European Medicines Agency review of ipilimumab (Yervoy) for the treatment of advanced (unresectable or metastatic) melanoma in adults who have received prior therapy: summary of the scientific assessment of the Committee for Medicinal Products for Human Use. Eur J Cancer. 2012;48:237–242. - PubMed
    1. Graziani G, Tentori L, Navarra P. Ipilimumab: a novel immunostimulatory monoclonal antibody for the treatment of cancer. Pharmacol Res. 2012;65:9–22. - PubMed
    1. U.S. Department of Health and Human Services. Common Terminology Criteria for Adverse Events (CTCAE). 2009-05-28, cited 2015-01-12; 80 screens. Available from: http://www.hrc.govt.nz/sites/default/files/CTCAE%20manual%20-%20DMCC.pdf.

Publication types

MeSH terms