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. 2017 Jul 5;6(10):e1344805.
doi: 10.1080/2162402X.2017.1344805. eCollection 2017.

Incidence of immune checkpoint inhibitor-related colitis in solid tumor patients: A systematic review and meta-analysis

Daniel Y Wang  1 , Fei Ye  2 , Shilin Zhao  2 , Douglas B Johnson  1
Affiliations

Incidence of immune checkpoint inhibitor-related colitis in solid tumor patients: A systematic review and meta-analysis

Daniel Y Wang et al. Oncoimmunology. .

Abstract

Background: With the rising use of immune checkpoint inhibitors (ICI) across varying tumors types, immune-related colitis is an increasingly encountered, serious adverse event requiring appropriate management. The incidence across ICI treatment regimens and tumor types is unclear. Objective: To characterize the incidence of immune-related colitis among various ICI regimens and tumor types. Methods: Thirty-four original studies of prospective ICI trials were identified based on a PubMed search completed on November 1st, 2016. Seventeen studies compared incidences across tumor types. The incidences of all-grade, grade 3-4 (severe) colitis, and grade 3-4 (severe) diarrhea were collected. Results: Thirty-four studies containing 8863 patients were included in the meta-analysis. The overall incidence during ipilimumab monotherapy was 9.1% for all-grade colitis, 6.8% for severe colitis, and 7.9% for severe diarrhea. The incidence was lowest during PD-1/PD-L1 inhibitor monotherapy with 1.3% for all-grade colitis, 0.9% for severe colitis and 1.2% for severe diarrhea, while combination ipilimumab and nivolumab resulted in the highest incidences of all-grade colitis (13.6%), severe colitis (9.4%) and severe diarrhea (9.2%) among ICIs. Among melanoma, NSCLC, RCC patients, incidences of colitis and diarrhea with PD-1/PD-L1 inhibitor monotherapy did not significantly differ. Severe colitis incidence was similar with ipilimumab monotherapy at 3 mg/kg and 10 mg/kg (7.1% vs 5.1%, respectively), but significantly higher for severe diarrhea with 10mg/kg (11.5% vs 5.2%). Conclusions: The incidence of immune-related colitis and severe diarrhea was higher with ipilimumab-containing regimens compared with PD-1/PD-L1 inhibitors. There was no significant difference in immune-related colitis between different tumor types with PD-1/L1 inhibitors.

Keywords: Immunotherapy; immune-related colitis; melanoma; meta-analysis; non-small cell lung cancer; renal cell carcinoma.

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Figures

Figure 1.
Figure 1.
PRISMA flowchart of included studies.
Figure 2.
Figure 2.
Forest plots of incidence of all-grade colitis in (A) ipilimumab, (B) anti-PD-1/L1 therapy, and (C) combination therapy.
Figure 3.
Figure 3.
Forest plots of incidence of G3–4 colitis in (A) ipilimumab, (B) anti-PD-1/L1 therapy, and (C) combination therapy.
Figure 4.
Figure 4.
Forest plot of incidence of grade 3–4 colitis in anti-PD-1/L1 therapy by tumor types: (A) melanoma, (B) renal cell carcinoma, (C) non-small cell lung cancer.
See this image and copyright information in PMC

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