According to the results of a retrospective study published in Molecular and Clinical Oncology, early initiation of highly immunosuppressive infliximab (IFX) and high-dose systemic steroid administration should be considered for diarrhoea/colitis and other immune-related adverse events (irAEs) in the setting of immune checkpoint inhibitor treatment. This article summarises the study and throws light on the outcomes of IFX treatment.

The authors of the study wrote:

“Immune‑related adverse events, which often occur in association with immune checkpoint inhibitor (ICI) treatment, require early detection and appropriate management considering their potentially fatal outcomes. Among irAEs, diarrhoea/colitis occurs particularly frequently, and serious complications, such as intestinal perforation, may follow unless timely and appropriate treatment is provided."

The study

In the current study, researchers examined the outcomes of IFX treatment in Japanese cancer patients who developed severe steroid-resistant irAEs secondary to various ICIs. They also assessed the efficacy and safety of IFX in the treatment of such irAEs.

Researchers examined the outcomes in eight patients with different types of cancers. Of these patients, four had malignant melanoma, three had lung cancer, and one had renal cancer.

These patients developed severe steroid-resistant irAEs after treatment with anti‑PD‑1, anti‑PD‑L1, and anti‑CTLA‑4 antibody preparations. Assessed data included patient background, examination data, imaging data, and treatment progress. They also assessed reactions via the Common Terminology Criteria for Adverse Events version 4.0.

Investigations

The investigators noted grade 3 diarrhoea/colitis in seven of eight patients and disseminated intravascular coagulation and myocarditis due to autoimmune activation in one patient. The median duration between systemic steroid and IFX treatments was 9 days, with three patients responding to IFX. Of note, one patient responded to IFX after one dose, while two patients responded after two doses. 

The investigators found that the complications improved to grade 0 following a median of 18 days, and no AEs were induced by IFX. Additionally, anti-cytomegalovirus (CMV) and antibacterial agents for CMV and Clostridium difficile (CD) infections were administered to seven patients. The one patient who responded to one dose of IFX did not require this intervention.

The authors wrote:

“Early initiation of IFX treatment in conjunction with systemic steroid therapy should be considered for severe diarrhea/colitis and other irAEs. However, the possibility for CMV and CD infections should be recognised, and for these the treatment strategy may need to be modified at an early stage.”

Re-evaluation

The researchers also recommended that re-evaluation for possible infections should be prompt. Importantly, clinicians should consider changing treatment to cyclosporine or vedolizumab if irAEs fail to respond to steroids or IFX treatment.

Side effects

Possible adverse effects of IFX include transient headache and nausea, however these are mild. In addition to symptoms of infectious reactions, clinicians must keep watch for medium- and long-term complications of aplastic anemia, malignant tumor, demyelinating diseases, autoimmune diseases, and heart failure.

This story is contributed by Naveed Saleh and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.