The characteristics of nivolumab-induced colitis: an evaluation of three cases and a literature review

Ryosuke Yamauchi, Toshihiro Araki, Keiichi Mitsuyama, Takaaki Tokito, Hidenobu Ishii, Shinichiro Yoshioka, Kotaro Kuwaki, Atsushi Mori, Tetsuhiro Yoshimura, Osamu Tsuruta, Takuji Torimura

The use of immune-checkpoint inhibitors in cancer treatment has become increasingly common, resulting in an increase in the incidence of related side effects. Diarrhoea and colitis have been previously documented as gastrointestinal tract-related side effects of immune-checkpoint inhibitors. Although PD-1/PD-L1 inhibitors produce fewer side effects than CTLA-4 inhibitors, diarrhoea and colitis continue to be reported. However, little is known about the endoscopic features associated with PD-1/PD-L1 inhibitors. In this report, we describe three cases of colitis induced by a PD-1 inhibitor nivolumab. These cases showed endoscopic findings characteristic of ulcerative colitis (UC). Treatment was in accordance with UC therapy, which resulted in beneficial outcomes. Three patients with lung cancer treated with nivolumab presented with diarrhoea with (case 2) or without haematochezia (cases 1 and 3). Treatment with nivolumab was ceased and colonoscopy was performed, revealing endoscopic features similar to those of UC. These patients were diagnosed with nivolumab-induced colitis. Case 1 was treated with mesalazine, whereas cases 2 and 3 were treated with corticosteroids. Subsequently, their symptoms improved. Nivolumab-induced colitis exhibited similar characteristics to UC. Treatment was similar to that for UC and was successful.