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- Title
Systematic review with meta‐analysis: effectiveness of anti‐inflammatory therapy in immune checkpoint inhibitor‐induced enterocolitis.
- Authors
Ibraheim, Hajir; Baillie, Samantha; Samaan, Mark A.; Abu‐Sbeih, Hamzah; Wang, Yinghong; Talley, Nicholas J.; P. Jones, Michael; Powell, Nick
- Abstract
Summary: Background: Immune checkpoint inhibitors have revolutionised cancer treatment, but at the cost of off‐target immune‐mediated organ damage. This includes checkpoint inhibitor‐induced enterocolitis which frequently requires hospitalisation and may be life‐threatening. Empiric treatment typically includes corticosteroids and infliximab, although no large‐scale studies have confirmed their effectiveness. Aim: To investigate the effectiveness of anti‐inflammatory therapy in checkpoint inhibitor‐induced enterocolitis Methods: We performed a systematic review and meta‐analysis of studies reporting clinical outcomes of checkpoint inhibitor‐induced enterocolitis in adult cancer patients treated with anti‐inflammatory agents. We searched Medline, EMBASE, and the Cochrane library through April and extracted the proportion of patients responding to anti‐inflammatory therapy. Variation in effect size was studied using a random‐effects meta‐regression analysis, with checkpoint inhibitor agent and tumour type as the variables. Results: Data were pooled from 1210 treated patients across 39 studies. Corticosteroids were effective in 59% (95% CI 54‐ 65) of patients, with response significantly more favourable in patients treated with anti‐PD‐1/L1 monotherapy, compared with anti‐CTLA‐4 containing regimens (78%, 95% CI 69‐85 vs 56 %, 95% CI 49‐63, P = 0.003), and more favourable in lung cancer patients compared with melanoma patients (88%, 95% CI 62‐97 vs 55%, 95% CI 47‐63, P = 0.04). Infliximab was effective in 81% (95% CI 73‐87) of patients, and vedolizumab in 85% (95% CI 60‐96). Conclusion: Corticosteroids, infliximab and vedolizumab, are effective in the treatment of checkpoint inhibitor‐induced enterocolitis. Checkpoint inhibitor regimen and cancer type were significant moderators in response to corticosteroid therapy.
- Subjects
META-analysis; PROGRAMMED cell death 1 receptors; IMMUNE checkpoint inhibitors; CANCER patients; ENTEROCOLITIS; ANTI-inflammatory agents; LUNG cancer
- Publication
Alimentary Pharmacology & Therapeutics, 2020, Vol 52, Issue 9, p1432
- ISSN
0269-2813
- Publication type
Article
- DOI
10.1111/apt.15998