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A retrospective analysis of patients with advanced non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICIs) showed multidisciplinary clinical management of immune-mediated diarrhea and colitis (IMDC) resulted in improved management of this immune-related adverse event (irAE). These results were published in The Oncologist.
In clinical management of solid tumors, irAEs pose a challenge, especially in the context of treatment with ICIs. The researchers retrospectively assessed data from a total of 607 patients with advanced NSCLC treated with ICIs in combination or as monotherapy between September 2013 and July 2022.
Of these patients, 13.8% (84 patients) experienced IMDC. Pathological assessment showed prevalence of microscopic colitis was 28%, with a collagenous pattern that associated with longer duration of symptoms (P = .01).
Both female patients and PD-L1 expressors more frequently experienced IMDC. Furthermore, occurrence of IMDC was correlated with longer progression-free survival (17.0 vs 5.8 months; P < .001) and overall survival (28.3 vs 9.5; P <.001).
Introducing multidisciplinary clinical management of IMDC correlated with increased use of certain diagnostic tools, including fecal calprotectin test (P <.001), gastroenterologic evaluation (P =.017), and colonoscopy (P <.001). Importantly, multidisciplinary management of IMDC also associated with a significant reduction in both recurrence after rechallenge (P =.016) and grade 3 conversion rate (P =.046). Although the hospitalization rate under multidisciplinary management decreased from 17.2% to 3.8%, this difference was not statistically significant.
These results emphasize the importance of integrating multidisciplinary clinical management into care for patients with advanced NSCLC receiving ICIs who experience IMDC as a mode of improving patient care and clinical outcomes. A prospective study is needed to validate these results and, according to the researchers, is being planned.
“[T]he impact of multidisciplinary discussion, even in the absence of institutionalized tumor board, is remarkable and clearly indicates the need to change our clinical approach to IMDC and irAEs in general,” concluded the authors.
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Reference
Bonanno L, Lorenzi M, Massa D, et al. Immune-related diarrhea and colitis in non-small cell lung cancers: impact of multidisciplinary management in a real-world setting. Oncologist. Published online August 21, 2023. doi:10.1093/oncolo/oyad238
