PMID- 35784625
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220716
IS  - 1108-7471 (Print)
IS  - 1792-7463 (Electronic)
IS  - 1108-7471 (Linking)
VI  - 35
IP  - 4
DP  - 2022 Jul-Aug
TI  - Clostridioides difficile infection in cancer patients receiving immune checkpoint 
      inhibitors.
PG  - 393-399
LID - 10.20524/aog.2022.0722 [doi]
AB  - BACKGROUND: Immune checkpoint inhibitors (ICIs) have revolutionized cancer 
      treatment, but are associated with immune-mediated diarrhea and colitis (IMDC). 
      Clostridioides difficile infection (CDI) can cause infectious diarrhea with 
      overlapping symptoms. Thus, we sought to elucidate the characteristics of CDI in 
      patients treated with ICI, in the context of IMDC. METHODS: We conducted a 
      retrospective, single-center study of adult cancer patients (N=421) with ICI 
      exposure from 2015-2020 and a positive stool nucleic acid amplification test 
      and/or enzyme immunoassay for CDI. Baseline characteristics, treatments, and 
      outcomes were compared between patients with and without concurrent IMDC. 
      RESULTS: Forty-one eligible patients were included, 27 with concurrent IMDC and 
      14 without. Twenty-seven patients were taking programmed death-1 or its ligand 
      inhibitors and 14 were taking cytotoxic T-lymphocyte-associated antigen 4 
      inhibitors. Patients with concurrent CDI and IMDC had a longer symptom duration 
      (20 vs. 5 days, P=0.003) and a higher rate of grade 3-4 diarrhea (41% vs. 7%, 
      P=0.033). Among patients with concurrent IMDC, preceding antibiotics (P=0.050) 
      and proton pump inhibitors (PPI) (P=0.038) were used more frequently among 
      individuals who developed CDI after immunosuppressant exposure. Thirty-eight 
      patients received antibiotics for CDI, while 5 required fecal microbiota 
      transplantation for concurrent CDI & IMDC. CONCLUSIONS: CDI is common in 
      ICI-treated cancer patients, especially those with IMDC requiring 
      immunosuppressants. Antibiotics did not alter the need for immunosuppressants in 
      those with concurrent IMDC. Use of PPI and antibiotics while receiving 
      immunosuppressants for IMDC was associated with a greater risk of CDI. Further 
      large-scale studies are warranted to clarify the role of CDI, antibiotics and 
      immunosuppression treatment in IMDC patients.
CI  - Copyright: (c) Hellenic Society of Gastroenterology.
FAU - Vasavada, Shaleen
AU  - Vasavada S
AD  - Department of Internal Medicine, Baylor College of Medicine, Houston, Texas 
      (Shaleen Vasavada, Kavea Panneerselvam).
FAU - Panneerselvam, Kavea
AU  - Panneerselvam K
AD  - Department of Internal Medicine, Baylor College of Medicine, Houston, Texas 
      (Shaleen Vasavada, Kavea Panneerselvam).
FAU - Amin, Rajan
AU  - Amin R
AD  - Department of Internal Medicine, The University of Texas Health Science Center, 
      Houston, Texas (Rajan Amin).
FAU - Varatharajalu, Krishnavathana
AU  - Varatharajalu K
AD  - Department of Gastroenterology, Hepatology, and Nutrition, The University of 
      Texas MD Anderson Cancer Center, Houston, Texas (Krishnavathana Varatharajalu, 
      Anusha S. Thomas, Yinghong Wang).
FAU - Okhuysen, Pablo C
AU  - Okhuysen PC
AD  - Department of Infectious Diseases, Infection Control, and Employee Health, The 
      University of Texas MD Anderson Cancer Center, Houston, Texas (Pablo C. 
      Okhuysen).
FAU - Oliva, Isabella C Glitza
AU  - Oliva ICG
AD  - Department of Melanoma Medical Oncology, The University of Texas MD Anderson 
      Cancer Center, Houston, Texas (Isabella C. Glitza Oliva).
FAU - Wang, Jianbo
AU  - Wang J
AD  - Department of Genitourinary Medical Oncology, The University of Texas MD Anderson 
      Cancer Center, Houston, Texas (Jianbo Wang).
FAU - Grivas, Petros
AU  - Grivas P
AD  - Department of Medicine, University of Washington, Fred Hutchinson Cancer Research 
      Center/Seattle Cancer Care Alliance, Seattle, Washington (Petros Grivas), USA.
FAU - Thomas, Anusha S
AU  - Thomas AS
AD  - Department of Gastroenterology, Hepatology, and Nutrition, The University of 
      Texas MD Anderson Cancer Center, Houston, Texas (Krishnavathana Varatharajalu, 
      Anusha S. Thomas, Yinghong Wang).
FAU - Wang, Yinghong
AU  - Wang Y
AD  - Department of Gastroenterology, Hepatology, and Nutrition, The University of 
      Texas MD Anderson Cancer Center, Houston, Texas (Krishnavathana Varatharajalu, 
      Anusha S. Thomas, Yinghong Wang).
LA  - eng
PT  - Journal Article
DEP - 20220602
PL  - Greece
TA  - Ann Gastroenterol
JT  - Annals of gastroenterology
JID - 101121847
PMC - PMC9210781
OTO - NOTNLM
OT  - Clostridioidesdifficile infection
OT  - Immune checkpoint inhibitors
OT  - immune-mediated diarrhea and colitis
COIS- Conflict of Interest: P. Grivas provided consulting to AstraZeneca, Astellas 
      Pharma, Bayer, Bristol Myers Squibb, Dyania Health, EMD Serono, Exelixis, 
      Foundation Medicine, Genentech/Roche, Genzyme, GlaxoSmithKline, Guardant Health, 
      Gilead Sciences, Infinity Pharmaceuticals, Janssen, Lucence Health, Merck, Mirati 
      Therapeutics, Pfizer, QED Therapeutics, Regeneron Pharmaceuticals, Seattle 
      Genetics, UroGen, SilverBack Therapeutics, 4D Pharma PLC. His institution has 
      received grants from Bavarian Nordic, Bristol Myers Squibb, Clovis Oncology, 
      Debiopharm, EMD Serono, G1 Therapeutics, Gilead Sciences, GlaxoSmithKline, Merck, 
      Mirati Therapeutics, Pfizer, QED Therapeutics. Dr. Wang has disclosed serving as 
      a consultant for Tillotts Pharma, and AzurRx Pharma.
EDAT- 2022/07/06 06:00
MHDA- 2022/07/06 06:01
PMCR- 2022/07/01
CRDT- 2022/07/05 10:27
PHST- 2022/02/05 00:00 [received]
PHST- 2022/04/01 00:00 [accepted]
PHST- 2022/07/05 10:27 [entrez]
PHST- 2022/07/06 06:00 [pubmed]
PHST- 2022/07/06 06:01 [medline]
PHST- 2022/07/01 00:00 [pmc-release]
AID - AnnGastroenterol-35-393 [pii]
AID - 10.20524/aog.2022.0722 [doi]
PST - ppublish
SO  - Ann Gastroenterol. 2022 Jul-Aug;35(4):393-399. doi: 10.20524/aog.2022.0722. Epub 
      2022 Jun 2.