Knocking Down Adverse Effects of Immunotherapy

Immune checkpoint inhibitors (ICIs) are successfully used against several types of cancer, but a common side effect of this immunotherapy is ICI-associated colitis, which occurs in up to 40% of patients. If sufficiently severe, treatment guidelines direct that ICI therapy be discontinued until the colitis is in remission. But results from a small study at MD Anderson Cancer Center, University of Texas suggest that fecal microbiota transplantation (FMT) may be an effective approach to treating severe refractory ICI-induced colitis. Lead researcher Yinghong Wang, MD, PhD, assistant professor of gastroenterology, hepatology and nutrition at MD Anderson, commented, “The resolution of colitis in these patients can be confirmed clinically and endoscopically after FMT treatment. Based on these results, this should be evaluated even as a first-line therapy for ICI-associated colitis because it’s safe, quick, and the effect is durable - from one treatment.” The findings were published earlier this week in Nature Medicine.

FMT involves transplantation of gut bacteria from healthy donors and has been used to treat other gastrointestinal conditions including Clostridium difficile infection and inflammatory bowel disease (IBD) that are similar to ICI-associated colitis. Results from 2 patients undergoing ICI therapy at MD Anderson found that complete resolution of their colitis was achieved with FMT treatment. Endoscopic examination showed that both patients evidenced reductions in inflammatory immune cells and significant improvement in inflammation and ulcerations. Acknowledging the limitations of a very small study size, the authors plan further clinical trials to evaluation the effectiveness of FMT vs standard immunosuppressive therapy for treating ICI-related colitis. Dr. Wang noted, “If the patient is a good responder to immunotherapy, (ICI colitis) means you’ve taken their effective treatment away. We have a limited amount of time to fix the problem so they can resume ICI treatment, but I feel that we’ve made great progress in this area.”

Read about the study.

The journal abstract may be read here.