Position Paper| Volume 54, ISSUE 9, P1162-1167, September 2022

Download started.


Management of immune checkpoint inhibitor in patients with cancer and pre-existing inflammatory bowel disease: Recommendations from the GETAID


      Background and aims

      There is no consensus on the management of immune checkpoint inhibitor (ICI) for treating cancer in patients with pre-existing inflammatory bowel disease (IBD). The Groupe d’Étude Thérapeutique des Affections Inflammatoires du tube Digestif (GETAID) aimed to provide recommendations on this topic.


      A dedicated working group performed a comprehensive expert-based review of the literature, generated clinical key question and shaped recommendations that were further voted for approval by the educational and scientific committees of the GETAID. Using consensus methods, treatment modalities were defined by vote.


      Majority of patients with IBD in clinical remission can be treated with ICI after cancer diagnosis. The rate of relapse or immune-related diarrhoea or colitis upon ICI treatment is up to 39.8% and is maximal with ICI combination therapy compared to monotherapies. When starting ICI in a patient with IBD, it is recommended to assess disease activity and pursue ongoing maintenance therapy. In case of relapse or immune-related diarrhoea or colitis upon ICI treatment, treatment depends on grading of diarrhoea or colitis and may include corticosteroid therapy, infliximab and/or vedolizumab.


      In the present publication, we provided recommendations, which may assist gastroenterologists, haematologists, and oncologists for a better management of patients with pre-existing IBD before and during cancer treatment with ICI.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Digestive and Liver Disease
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Bagchi S.
        • Yuan R.
        • Engleman E.G
        Immune checkpoint inhibitors for the treatment of cancer: clinical impact and mechanisms of response and resistance.
        Annu Rev Pathol. 2021; 16: 223-249
        • Samaan M.A.
        • Pavlidis P.
        • Papa S.
        • Powell N.
        • Irving P.M
        Gastrointestinal toxicity of immune checkpoint inhibitors: from mechanisms to management.
        Nat Rev Gastroenterol Hepatol. 2018; 15: 222-234
        • Soularue E.
        • Lepage P.
        • Colombel J.F.
        • Coutzac C.
        • Faleck D.
        • Marthey L.
        • et al.
        Enterocolitis due to immune checkpoint inhibitors: a systematic review.
        Gut. 2018; 67: 2056-2067
        • Powell N.
        • Ibraheim H.
        • Raine T.
        • Speight R.A.
        • Papa S.
        • Brain O.
        • et al.
        British Society of Gastroenterology endorsed guidance for the management of immune checkpoint inhibitor-induced enterocolitis.
        Lancet Gastroenterol Hepatol. 2020; 5: 679-697
        • Baxi S.
        • Yang A.
        • Gennarelli R.L.
        • Khan N.
        • Wang Z.
        • Boyce L.
        • et al.
        Immune-related adverse events for anti-PD-1 and anti-PD-L1 drugs: systematic review and meta-analysis.
        BMJ. 2018; 360: k793
        • Collins M.
        • Soularue E.
        • Marthey L.
        • Carbonnel F
        Management of patients with immune checkpoint inhibitor-induced enterocolitis: a systematic review.
        Clin Gastroenterol Hepatol. 2020; 18 (e1): 1393-1403
        • Komaki Y.
        • Komaki F.
        • Yamada A.
        • Micic D.
        • Ido A.
        • Sakuraba A
        Meta-analysis of the risk of immune-related adverse events with anticytotoxic T-lymphocyte-associated antigen 4 and antiprogrammed death 1 therapies.
        Clin Pharmacol Ther. 2018; 103: 318-331
        • Zhang B.
        • Wu Q.
        • Zhou Y.L.
        • Guo X.
        • Ge J.
        • Fu J
        Immune-related adverse events from combination immunotherapy in cancer patients: a comprehensive meta-analysis of randomized controlled trials.
        Int Immunopharmacol. 2018; 63: 292-298
        • De Velasco G.
        • Je Y.
        • Bossé D.
        • Awad M.M.
        • Ott P.A.
        • Moreira R.B.
        • et al.
        Comprehensive meta-analysis of key immune-related adverse events from CTLA-4 and PD-1/PD-L1 inhibitors in cancer patients.
        Cancer Immunol Res. 2017; 5: 312-318
        • Tandon P.
        • Bourassa-Blanchette S.
        • Bishay K.
        • Parlow S.
        • Laurie S.A.
        • McCurdy J.D
        The risk of diarrhea and colitis in patients with advanced melanoma undergoing immune checkpoint inhibitor therapy: a systematic review and meta-analysis.
        J Immunother. 2018; 41: 101-108
        • Chaput N.
        • Lepage P.
        • Coutzac C.
        • Soularue E.
        • Le Roux K.
        • Monot C.
        • et al.
        Baseline gut microbiota predicts clinical response and colitis in metastatic melanoma patients treated with ipilimumab.
        Ann Oncol. 2017; 28: 1368-1379
        • Gopalakrishnan V.
        • Spencer C.N.
        • Nezi L.
        • Reuben A.
        • Andrews M.C.
        • Karpinets T.V.
        • et al.
        Gut microbiome modulates response to anti-PD-1 immunotherapy in melanoma patients.
        Science. 2018; 359: 97-103
        • Vétizou M.
        • Pitt J.M.
        • Daillère R.
        • Lepage P.
        • Waldschmitt N.
        • Flament C.
        • et al.
        Anticancer immunotherapy by CTLA-4 blockade relies on the gut microbiota.
        Science. 2015; 350: 1079-1084
        • Sivan A.
        • Corrales L.
        • Hubert N.
        • Williams J.B.
        • Aquino-Michaels K.
        • Earley Z.M.
        • et al.
        Commensal Bifidobacterium promotes antitumor immunity and facilitates anti-PD-L1 efficacy.
        Science. 2015; 350: 1084-1089
        • Torres J.
        • Mehandru S.
        • Colombel J.-.F.
        • Peyrin-Biroulet L
        Crohn's disease.
        Lancet. 2017; 389: 1741-1755
        • Ungaro R.
        • Mehandru S.
        • Allen P.B.
        • Peyrin-Biroulet L.
        • Colombel J.-.F
        Ulcerative colitis.
        Lancet. 2017; 389: 1756-1770
        • Caruso R.
        • Lo B.C.
        • Núñez G
        Host-microbiota interactions in inflammatory bowel disease.
        Nat Rev Immunol. 2020; 20: 411-426
        • van der Kooij M.K.
        • Suijkerbuijk K.P.M.
        • Aarts M.J.B.
        • van den Berkmortel F.W.P.J.
        • Blank C.U.
        • Boers-Sonderen M.J.
        • et al.
        Safety and efficacy of checkpoint inhibition in patients with melanoma and preexisting autoimmune disease : a cohort study.
        Ann Intern Med. 2021; 174: 641-648
        • Meserve J.
        • Facciorusso A.
        • Holmer A.K.
        • Annese V.
        • Sandborn W.J.
        • Singh S
        Systematic review with meta-analysis: safety and tolerability of immune checkpoint inhibitors in patients with pre-existing inflammatory bowel diseases.
        Aliment Pharmacol Ther. 2021; 53: 374-382
      1. National Cancer Institute. Common terminology criteria for adverse events (CTCAE) n.d., June 14, 2010.

        • Ma C.
        • MacDonald J.K.
        • Nguyen T.M.
        • Chang J.
        • Vande Casteele N.
        • Feagan B.G.
        • et al.
        Systematic review: disease activity indices for immune checkpoint inhibitor-associated enterocolitis.
        Aliment Pharmacol Ther. 2022; 55: 178-190
        • Sleiman J.
        • Wei W.
        • Shah R.
        • Faisal M.S.
        • Philpott J.
        • Funchain P
        Incidence of immune checkpoint inhibitor-mediated diarrhea and colitis (imDC) in patients with cancer and preexisting inflammatory bowel disease: a propensity score-matched retrospective study.
        J Immunother Cancer. 2021; 9e002567
        • Alexander S.
        • Swami U.
        • Kaur A.
        • Gao Y.
        • Fatima M.
        • Ginn M.M.
        • et al.
        Safety of immune checkpoint inhibitors in patients with cancer and pre-existing autoimmune disease.
        Ann Transl Med. 2021; 9: 1033
        • Abu-Sbeih H.
        • Faleck D.M.
        • Ricciuti B.
        • Mendelsohn R.B.
        • Naqash A.R.
        • Cohen J.V.
        • et al.
        Immune checkpoint inhibitor therapy in patients with preexisting inflammatory bowel disease.
        J Clin Oncol. 2020; 38: 576-583
        • Gomollón F.
        • Dignass A.
        • Annese V.
        • Tilg H.
        • Van Assche G.
        • Lindsay J.O.
        • et al.
        3rd European evidence-based consensus on the diagnosis and management of Crohn's disease 2016: part 1: diagnosis and medical management.
        J Crohns Colitis. 2017; 11: 3-25
        • Magro F.
        • Gionchetti P.
        • Eliakim R.
        • Ardizzone S.
        • Armuzzi A.
        • Barreiro-de Acosta M.
        • et al.
        Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 1: definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders.
        J Crohns Colitis. 2017; 11: 649-670
        • Lamb C.A.
        • Kennedy N.A.
        • Raine T.
        • Hendy P.A.
        • Smith P.J.
        • Limdi J.K.
        • et al.
        British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults.
        Gut. 2019; 68: s1-106
        • Abdel-Wahab N.
        • Shah M.
        • Lopez-Olivo M.A.
        • Suarez-Almazor M.E
        Use of immune checkpoint inhibitors in the treatment of patients with cancer and preexisting autoimmune disease: a systematic review.
        Ann Intern Med. 2018; 168: 121-130
        • Esfahani K.
        • Hudson M.
        • Batist G
        Tofacitinib for refractory immune-related colitis from PD-1 therapy.
        N Engl J Med. 2020; 382: 2374-2375
        • Thomas A.S.
        • Ma W.
        • Wang Y
        Ustekinumab for refractory colitis associated with immune checkpoint inhibitors.
        N Engl J Med. 2021; 384: 581-583
        • Henderson Berg M.-.H.
        • Del Rincón S.V.
        • Miller W.H
        Potential therapies for immune-related adverse events associated with immune checkpoint inhibition: from monoclonal antibodies to kinase inhibition.
        J Immunother Cancer. 2022; 10e003551
        • Dougan M.
        • Luoma A.M.
        • Dougan S.K.
        • Wucherpfennig K.W
        Understanding and treating the inflammatory adverse events of cancer immunotherapy.
        Cell. 2021; 184: 1575-1588
        • Dougan M.
        • Wang Y.
        • Rubio-Tapia A.
        • Lim J.K
        AGA clinical practice update on diagnosis and management of immune checkpoint inhibitor colitis and hepatitis: expert review.
        Gastroenterology. 2021; 160: 1384-1393