Prevalence of enteric infections in patients on immune checkpoint inhibitors and impact on management and outcomes Journal Article
| Authors: | Magahis, P. T.; Satish, D.; Babady, N. E.; Kamboj, M.; Postow, M. A.; Laszkowska, M.; Faleck, D. M. |
| Article Title: | Prevalence of enteric infections in patients on immune checkpoint inhibitors and impact on management and outcomes |
| Abstract: | Background: Stool pathogen testing is recommended as part of the initial evaluation for patients with new-onset diarrhea on immune checkpoint inhibitors (ICIs), yet its significance has not been well-studied. We aimed to determine the impact of multiplex gastrointestinal (GI) pathogen PCR testing on the clinical course and use of immunosuppressive therapy in patients who develop diarrhea on ICIs. Methods: This retrospective cohort included individuals who underwent GI pathogen panel PCR for diarrhea on ICIs at Memorial Sloan Kettering between 7/2015 and 7/2021. The primary outcome was use of immunosuppressive therapy for suspected immunotherapy-related enterocolitis (irEC). Secondary outcomes included diarrhea severity and endoscopic and histologic disease patterns. Results: Among 521 ICI-treated patients tested for GI pathogens, 61 (11.7%) had a positive PCR. Compared to patients without detectable infections, patients with infections had more frequent grades 3-4 diarrhea (37.7% vs. 19.6%, P < .01) and colitis (39.3% vs. 14.7%, P < .01). However, patients with infections did not have higher rates of persistent or recurrent diarrhea and were less likely to receive steroids (P < .01) and second-line immunosuppressive agents (P = .03). In 105 patients with lower endoscopy, similar trends were observed and no differences in endoscopic severity or histologic patterns were noted between groups. Conclusions: GI infections in ICI-treated patients presenting with diarrhea are linked to more severe but self-limited clinical presentations and may be optimally treated with observation and supportive care alone. Routine and timely stool pathogen testing may help avert unnecessary empiric immunosuppression for suspected irEC, which has been linked to blunted antitumor responses and numerous adverse effects. © 2024 Wiley-Blackwell. All rights reserved. |
| Keywords: | retrospective studies; diarrhea; prevalence; pathology; retrospective study; colitis; immune checkpoint inhibitor; humans; human; immune checkpoint inhibitors; enteric infections; gi pcr; immune-related enterocolitis |
| Journal Title: | The Oncologist |
| Volume: | 29 |
| Issue: | 1 |
| ISSN: | 1083-7159 |
| Publisher: | Oxford University Press |
| Date Published: | 2024-01-01 |
| Start Page: | 36 |
| End Page: | 46 |
| Language: | English |
| DOI: | 10.1093/oncolo/oyad226 |
| PUBMED: | 37721546 |
| PROVIDER: | scopus |
| PMCID: | PMC10769809 |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed and PDF -- MSK corresponding author is David Faleck -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
Related MSK Work