免疫检查点抑制剂治疗患者艰难梭菌感染的管理和结果。

IF 14.8 2区 医学 Q1 ONCOLOGY
Patrick T Magahis, Deepika Satish, Mini Kamboj, Ngolela Esther Babady, Jennele Baul, Hannah L Kalvin, Katherine Panageas, Michael A Postow, Monika Laszkowska, David M Faleck
{"title":"免疫检查点抑制剂治疗患者艰难梭菌感染的管理和结果。","authors":"Patrick T Magahis, Deepika Satish, Mini Kamboj, Ngolela Esther Babady, Jennele Baul, Hannah L Kalvin, Katherine Panageas, Michael A Postow, Monika Laszkowska, David M Faleck","doi":"10.6004/jnccn.2024.7355","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Data on the severity, management, and outcomes of Clostridioides difficile infection (CDI) in patients presenting with diarrhea while receiving immune checkpoint inhibitors (ICIs) are limited. This study aimed to evaluate the course of CDI in this population and the overlapping diagnosis of immune-related enterocolitis (irEC).</p><p><strong>Methods: </strong>This retrospective cohort included ICI-treated patients who presented with diarrhea and underwent CDI stool nucleic acid amplification PCR testing at Memorial Sloan Kettering Cancer Center between July 2015 and July 2021. Primary outcomes included CDI frequency, treatment regimens, and the need for immunosuppression for irEC.</p><p><strong>Results: </strong>Among 605 ICI-treated patients presenting with diarrhea, 111 (18%) tested positive for CDI. Of these, 84 (76%) were successfully treated with antibiotics alone, whereas 27 (24%) received additional immunosuppressive therapy for suspected or confirmed irEC. Compared with CDI-negative patients, those with CDI had higher rates of prior antibiotic exposure, abdominal pain, fever, bloody stools, and more severe diarrhea and colitis. However, they had lower rates of irEC requiring immunosuppression. Factors associated with the receipt of immunosuppression included CTLA-4-based immunotherapy and grade 3-4 diarrhea and colitis. The CDI recurrence rate was 20%, regardless of the treatment regimen used.</p><p><strong>Conclusions: </strong>In the largest cohort to date of ICI-treated patients with diarrhea, CDI was identified in 18% of cases and was associated with prior antibiotic therapy. Most patients responded to antibiotics alone; however, 24% required immunosuppression for concurrent irEC, and 20% experienced CDI recurrence. Prompt CDI testing and thoughtful clinical treatment and monitoring may improve outcomes in this population.</p>","PeriodicalId":17483,"journal":{"name":"Journal of the National Comprehensive Cancer Network","volume":"23 5","pages":"147-155"},"PeriodicalIF":14.8000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Management and Outcomes of Clostridioides difficile Infection in Patients on Immune Checkpoint Inhibitors.\",\"authors\":\"Patrick T Magahis, Deepika Satish, Mini Kamboj, Ngolela Esther Babady, Jennele Baul, Hannah L Kalvin, Katherine Panageas, Michael A Postow, Monika Laszkowska, David M Faleck\",\"doi\":\"10.6004/jnccn.2024.7355\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Data on the severity, management, and outcomes of Clostridioides difficile infection (CDI) in patients presenting with diarrhea while receiving immune checkpoint inhibitors (ICIs) are limited. This study aimed to evaluate the course of CDI in this population and the overlapping diagnosis of immune-related enterocolitis (irEC).</p><p><strong>Methods: </strong>This retrospective cohort included ICI-treated patients who presented with diarrhea and underwent CDI stool nucleic acid amplification PCR testing at Memorial Sloan Kettering Cancer Center between July 2015 and July 2021. Primary outcomes included CDI frequency, treatment regimens, and the need for immunosuppression for irEC.</p><p><strong>Results: </strong>Among 605 ICI-treated patients presenting with diarrhea, 111 (18%) tested positive for CDI. Of these, 84 (76%) were successfully treated with antibiotics alone, whereas 27 (24%) received additional immunosuppressive therapy for suspected or confirmed irEC. Compared with CDI-negative patients, those with CDI had higher rates of prior antibiotic exposure, abdominal pain, fever, bloody stools, and more severe diarrhea and colitis. However, they had lower rates of irEC requiring immunosuppression. Factors associated with the receipt of immunosuppression included CTLA-4-based immunotherapy and grade 3-4 diarrhea and colitis. The CDI recurrence rate was 20%, regardless of the treatment regimen used.</p><p><strong>Conclusions: </strong>In the largest cohort to date of ICI-treated patients with diarrhea, CDI was identified in 18% of cases and was associated with prior antibiotic therapy. Most patients responded to antibiotics alone; however, 24% required immunosuppression for concurrent irEC, and 20% experienced CDI recurrence. Prompt CDI testing and thoughtful clinical treatment and monitoring may improve outcomes in this population.</p>\",\"PeriodicalId\":17483,\"journal\":{\"name\":\"Journal of the National Comprehensive Cancer Network\",\"volume\":\"23 5\",\"pages\":\"147-155\"},\"PeriodicalIF\":14.8000,\"publicationDate\":\"2025-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the National Comprehensive Cancer Network\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.6004/jnccn.2024.7355\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the National Comprehensive Cancer Network","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.6004/jnccn.2024.7355","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0

摘要

背景:在接受免疫检查点抑制剂(ICIs)治疗的腹泻患者中,艰难梭菌感染(CDI)的严重程度、管理和结局数据有限。本研究旨在评估该人群的CDI病程和免疫相关性小肠结肠炎(irEC)的重叠诊断。方法:该回顾性队列包括2015年7月至2021年7月在纪念斯隆凯特琳癌症中心接受ci治疗的腹泻患者,并进行了CDI粪便核酸扩增PCR检测。主要结局包括CDI频率、治疗方案和irEC的免疫抑制需求。结果:605例接受ici治疗的腹泻患者中,111例(18%)检测出CDI阳性。其中84例(76%)成功地单独使用抗生素治疗,而27例(24%)因疑似或确诊irEC接受了额外的免疫抑制治疗。与CDI阴性患者相比,CDI患者既往抗生素暴露、腹痛、发热、便血、更严重的腹泻和结肠炎的发生率更高。然而,他们需要免疫抑制的irEC发生率较低。与接受免疫抑制相关的因素包括基于ctla -4的免疫治疗和3-4级腹泻和结肠炎。无论采用何种治疗方案,CDI复发率均为20%。结论:在迄今为止最大的ici治疗腹泻患者队列中,18%的病例中发现CDI,并且与既往抗生素治疗相关。大多数患者仅对抗生素有反应;然而,24%的并发irEC需要免疫抑制,20%的CDI复发。及时的CDI检测和周到的临床治疗和监测可能会改善这一人群的预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Management and Outcomes of Clostridioides difficile Infection in Patients on Immune Checkpoint Inhibitors.

Background: Data on the severity, management, and outcomes of Clostridioides difficile infection (CDI) in patients presenting with diarrhea while receiving immune checkpoint inhibitors (ICIs) are limited. This study aimed to evaluate the course of CDI in this population and the overlapping diagnosis of immune-related enterocolitis (irEC).

Methods: This retrospective cohort included ICI-treated patients who presented with diarrhea and underwent CDI stool nucleic acid amplification PCR testing at Memorial Sloan Kettering Cancer Center between July 2015 and July 2021. Primary outcomes included CDI frequency, treatment regimens, and the need for immunosuppression for irEC.

Results: Among 605 ICI-treated patients presenting with diarrhea, 111 (18%) tested positive for CDI. Of these, 84 (76%) were successfully treated with antibiotics alone, whereas 27 (24%) received additional immunosuppressive therapy for suspected or confirmed irEC. Compared with CDI-negative patients, those with CDI had higher rates of prior antibiotic exposure, abdominal pain, fever, bloody stools, and more severe diarrhea and colitis. However, they had lower rates of irEC requiring immunosuppression. Factors associated with the receipt of immunosuppression included CTLA-4-based immunotherapy and grade 3-4 diarrhea and colitis. The CDI recurrence rate was 20%, regardless of the treatment regimen used.

Conclusions: In the largest cohort to date of ICI-treated patients with diarrhea, CDI was identified in 18% of cases and was associated with prior antibiotic therapy. Most patients responded to antibiotics alone; however, 24% required immunosuppression for concurrent irEC, and 20% experienced CDI recurrence. Prompt CDI testing and thoughtful clinical treatment and monitoring may improve outcomes in this population.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
CiteScore
20.20
自引率
0.00%
发文量
388
审稿时长
4-8 weeks
期刊介绍: JNCCN—Journal of the National Comprehensive Cancer Network is a peer-reviewed medical journal read by over 25,000 oncologists and cancer care professionals nationwide. This indexed publication delivers the latest insights into best clinical practices, oncology health services research, and translational medicine. Notably, JNCCN provides updates on the NCCN Clinical Practice Guidelines in Oncology® (NCCN Guidelines®), review articles elaborating on guideline recommendations, health services research, and case reports that spotlight molecular insights in patient care. Guided by its vision, JNCCN seeks to advance the mission of NCCN by serving as the primary resource for information on NCCN Guidelines®, innovation in translational medicine, and scientific studies related to oncology health services research. This encompasses quality care and value, bioethics, comparative and cost effectiveness, public policy, and interventional research on supportive care and survivorship. JNCCN boasts indexing by prominent databases such as MEDLINE/PubMed, Chemical Abstracts, Embase, EmCare, and Scopus, reinforcing its standing as a reputable source for comprehensive information in the field of oncology.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信