Summary of the Two Cases Who Developed ICI-Induced Colitis Case 1 A 67-year-old man diagnosed with metastatic renal cell carcinoma received nivolumab after being refractory to axitinib. April 2016 and July 2020 at Keio University Hospital. Next, second-generation capsule endoscopy (CCE-2) was performed on day 60 after ICI initiation to explore the entire gastrointestinal tract. Results: Among the 30 patients enrolled herein, 23 underwent CCE-2. Accordingly, a total of 23 findings were observed in 14 (60.8%) patients at any portion of the gastrointestinal tract (7 patients in the colon, 4 patients in the small intestine, 2 patients in both the colon JNJ-39758979 and the small intestine, and 1 patient in the stomach). After capsule endoscopy, 2 patients (8.7%) developed ICI-induced enterocolitis: both had significantly higher Capsule Scoring of Ulcerative Colitis than those who had not developed ICI-induced enterocolitis (= 0.0455). No adverse events related to CCE-2 were observed. Conclusions: CCE-2 might be a safe and useful entire intestinal tract screening method for the early detection of ICI-induced enterocolitis in patients with malignancies. value smaller than 0.05 ( 0.05). 3.2. Positive Capsule Endoscopy Findings Among the evaluated patients, 14 had a total of 23 gastrointestinal tract findings (positive-finding group), whereas 9 had no endoscopic findings (no-finding group). Patients characteristics at baseline were similar in both groups. The Lichtiger index was not statistically different between the patients with capsule endoscopy findings (median, 0; range, 0C1) and those without any findings (median, 0; range, 0C3) (= 0.38). Findings were observed in the colon in 9 patients (39.1%; 9 proximal and/or 4 distal) and in the small intestine in 6 patients (26.1%) (Figure 2), respectively. Moreover, 8 patients (34.8%) had some findings showing multiple lesions across the gastrointestinal tract. Typical CCE-2 findings are summarized in Figure 3. Evaluation of the small intestine revealed that 1 patient had multiple scattered edematous lesions and 4 patients had erosions. Open in a separate window Figure 2 Distribution of positive findings detected pursuing capsule endoscopy. Abbreviations: GC, gastric cancers; M, male; Rabbit polyclonal to Akt.an AGC kinase that plays a critical role in controlling the balance between survival and AP0ptosis.Phosphorylated and activated by PDK1 in the PI3 kinase pathway. MM, malignant melanoma; MSI-H, microsatellite instability-high; RCC, renal cell carcinoma. Open up in another window Amount 3 Capsule endoscopy results detected in today’s study. (A) Scar tissue on the proximal digestive tract, (B) erosion on the proximal digestive tract, (C) erosion on the distal digestive tract, (D) erosion on the distal digestive tract, (E) inflammation on the proximal digestive tract, (F) ulceration on the ileum, (G) inflammation at the tummy, (H) edematous mucosa on the tummy. The positive-finding group acquired a median CSUC of just one 1 (range, 0C4). The most regularly observed results included vascular patterns (9 lesions in 7 sufferers) and ulcer and/or erosions (8 lesions in 5 sufferers). A summary of the CSUC in the positive-finding group is normally presented in Amount 4. Two sufferers (observed as * in Amount 2) created ICI-induced colitis of quality 2 after CCE-2 security and had been administered immunosuppressive remedies. Two sufferers who created ICI-induced colitis acquired two vascular patterns and four ulcers and/or erosions. Sufferers who didn’t develop ICI-induced colitis (n = 12) acquired seven vascular patterns at any lesions and four ulcers and/or erosions. There is a big change between the groupings with regards to the regularity of ulcers and/or erosions noticed through the capsule endoscopy (= 0.0139); nevertheless, there is no statistical difference between your groups in regards to to the regularity of vascular patterns (= 0.122). Sufferers with ICI-induced colitis also acquired a considerably higher CSUC (4 and 3) compared to the 12 sufferers who didn’t develop ICI-induced colitis (= 0.0445). Open up in another window Amount 4 Capsule Credit scoring of Ulcerative Colitis for the 14 sufferers who JNJ-39758979 demonstrated positive findings pursuing capsule endoscopy. * Two sufferers developed immune system checkpoint inhibitor-induced JNJ-39758979 colitis after capsule endoscopy. Abbreviations: CSUC, Capsule Credit scoring of Ulcerative Colitis; ICI, immune system checkpoint inhibitors. 3.3. Overview of both Cases Who Established ICI-Induced Colitis Case 1 A 67-year-old guy identified as having metastatic renal cell carcinoma received nivolumab after getting refractory to axitinib. Nevertheless, CCE-2 performed 60 times after nivolumab initiation demonstrated erosions in the proximal digestive tract,.