Side Effect: Inflammation of the colon (colitis)

What is Inflammation of the colon (colitis)?

Inflammation of the colon, otherwise known as colitis, is a condition characterized by inflammation of the large intestine.
Colitis can be acute (short in duration) in cases of:

• infectious colitis
• ischemic colitis (reduced blood flow to the intestine)
• radiation colitis
• drug-induced colitis

Or, Colitis can be chronic (long-lasting) as seen with:

• Crohn’s disease
• ulcerative colitis

What does Inflammation of the colon (colitis) look like?

Colitis can look different depending upon the type and severity of the inflammation.

Symptoms of colitis include:

• watery diarrhea
• cramping
• abdominal pain
• bloating
• fever
• mucus and/or blood in the stool

Who gets Inflammation of the colon (colitis)?

Patients with cancer can develop colitis as a side effect of cancer treatment, which tends to have a rapid onset. Colitis can occur as an immune-related adverse event (irAE) in patients with cancer who are receiving immune checkpoint inhibitor (ICI) therapy such as:

PD-1 inhibitors:

• pembrolizumab (Keytruda®)
• nivolumab (Opdivo®)
• cemiplimab (Libtayo®)
• dostarlimab (Jemperli®)
• retifanlimab (Zynyz®)
• toripalimab (Loqtorzi®)

PD-L1 inhibitors:

• atezolizumab (Tecentriq®)
• durvalumab (Imfinzi®)
• avelumab (Bavencio®)

CTLA-4 inhibitors:

• ipilimumab (Yervoy®)
• tremelimumab (Imjudo®

ICIs activate the immune system against cancer cells, but they can also trigger an immune response against healthy tissues, including tissue the gastrointestinal (GI) tract, leading to colitis. ICIs can cause colitis when used alone, but the incidence is higher when two ICI therapies are combined such as a PD-1 inhibitor and CTLA-4 inhibitor.

How to prevent Inflammation of the colon (colitis)

Before treatment:

• Preventing colitis in patients with cancer can be challenging. Patients should be carefully screened before starting treatment to identify any preexisting conditions that could increase the risk of colitis.

During Treatment:

• Patients should be monitored closely and have their treatment adjusted as needed. Patients should be educated about the signs and symptoms of colitis and advised to seek medical attention promptly if they experience any of these symptoms.

How to treat Inflammation of the colon (colitis)

• Treatment for colitis in patients with cancer typically involves stopping the treatment that is causing the colitis, and using medications to control symptoms and reduce inflammation in the colon.
• Mild cases may be treated outpatient with anti-diarrheal medications such as loperamide (Imodium®) and budesonide (Entocort®), an oral corticosteroid that does not get absorbed well into the blood stream and mainly stays in the GI tract where it acts locally.
• More severe cases may require hospitalization and use of systemic glucocorticoids such as prednisone (Deltasone®) or methylprednisolone (Solu-Medrol®).
  • For patients that do not respond well enough to glucocorticoids, intravenous immunosuppressive medications such as infliximab (Remicade®, Renflexis®, Inflectra®) or vedolizumab (Entyvio®) may be used.
  • For those who don’t respond to infliximab or vedolizumab, other treatment options that may be considered include tofacitinib (Xeljanz®) or ustekinumab (Stelara®).
• In some cases, surgery may be necessary to remove the affected part of the colon.