Vedolizumab: a novel treatment for ipilimumab-induced colitis

Abstract

Use of the immune checkpoint inhibitors, ipilimumab and nivolumab, has revolutionised treatment in patients with metastatic melanoma. However, these drugs can cause an autoimmune enterocolitis, with diarrhoea as the presenting symptom. This is conventionally managed by prompt institution of corticosteroid therapy if moderate diarrhoea (3-6 times/day; grade 2) is present for >5 days or if diarrhoea is severe (>6 times/day; grade 3). We report a case of steroid-dependent ipilimumab-induced colitis successfully treated with vedolizumab (an inhibitor of memory T-cell trafficking to the gut), after which complete withdrawal of corticosteroid was achieved. Hence, vedolizumab warrants further evaluation as a potential novel treatment of ipilimumab-induced colitis.

Figure 1

Diagram showing timing of treatment and severity of diarrhoea. MMX, oral budesonide.

Figure 2

Mild active colitis on flexible sigmoidoscopy.

Figure 3

H&E image at ×20 objective magnification showing mucus depletion, increased cellularity of the lamina propria due to a mixed inflammatory infiltrate and crypt abscess.