Journal Article

Anti-PD1-/PDL1-induced chronic intestinal pseudo-obstruction: three cases treated with vedolizumab after corticosteroid failure with mixed results

Bocquet, François, Collins, Michael, Farina, Antonio, Alberto, Tifanie, Dumont, Frederic, Saint-Jean, Mélanie, Joubert, Bastien, Honnorat, Jérôme, Zenatri, Morgan, Collardeau-Frachon, Sophie, Raimbourg, Judith

2025

Overview

Immune checkpoint inhibitors (ICI), i.e., anti-PD1/PDL1 and anti-CTLA-4, have reshaped the prognosis of many cancers. Increased use of ICI has led to the onset of new adverse events. Neurological immune-related adverse events are rare, heterogenous, and potentially life-threatening. Chronic intestinal pseudo-obstruction (CIPO) is an immune-related autonomic plexus neuropathy that may be caused by infiltration of the myenteric plexus by CD8 + T cells. It is a rare and potentially fatal side effect that can be difficult to diagnose early because of initial nonspecific clinical presentation including vomiting, nausea, diarrhea, and constipation. Some rare cases have been described in the literature reporting a frequent resistance to corticosteroids making it necessary to use other immunosuppressive therapy. Vedolizumab is an antibody (Ab) blocking integrin α4-β7 used to treat inflammatory bowel disease. We report the first three cases of ICI-induced CIPO-treated with vedolizumab after corticosteroid failure, with very limited benefits (only one patient with transitory improvement). Based on our results in three cases, vedolizumab does not currently appear to be a therapeutic option. Earlier administration with a standardized dose and frequency schedule may provide better outcomes.

• Publisher: Springer Berlin Heidelberg,Springer Nature B.V,Springer Verlag,Springer
• Subject: Adrenal Cortex Hormones / Adrenal Cortex Hormones - therapeutic use / Adverse events / Aged / Anti-PD1 / Antibodies, Monoclonal, Humanized / Antibodies, Monoclonal, Humanized - adverse effects / Antibodies, Monoclonal, Humanized - therapeutic use / Autonomic nervous system / B7-H1 Antigen / B7-H1 Antigen - antagonists & inhibitors / Brief Report / Cancer / Cancer Research / CD8 antigen / Chronic Disease / Chronic intestinal pseudo-obstruction / Constipation / Corticosteroids / CTLA-4 protein / Diarrhea / Enteric nervous system / Female / Gastrointestinal Agents / Gastrointestinal Agents - adverse effects / Gastrointestinal Agents - therapeutic use / Human health and pathology / Humans / Hépatology and Gastroenterology / Immune Checkpoint Inhibitors / Immune Checkpoint Inhibitors - adverse effects / Immune Checkpoint Inhibitors - therapeutic use / Immunology / Immunosuppressive agents / Immunotherapy / Inflammatory bowel diseases / Intestinal Pseudo-Obstruction / Intestinal Pseudo-Obstruction - chemically induced / Intestine / Life Sciences / Lymphocytes T / Male / Medicine / Medicine & Public Health / Middle Aged / Monoclonal antibodies / Myenteric plexus / Neuropathy / NSCLC / Oncology / PD-1 protein / Programmed Cell Death 1 Receptor / Programmed Cell Death 1 Receptor - antagonists & inhibitors / Steroids / Vedolizumab