Post written by Yinghong Wang, MD, PhD, from the Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.

To our knowledge, this is the largest multicenter study to develop an endoscopic scoring system for guiding management of immune-mediated colitis (IMC) in cancer care. This scoring system has demonstrated superiority over clinical symptom assessment alone in accurately measuring severity and determining the need for more aggressive medical treatments, such as selective immunosuppressive therapy (SIT) (ie, infliximab, vedolizumab).

Immune checkpoint inhibitor therapy has become the standard of care for patients with various cancers, offering high efficacy. However, it also gives rise to systemic toxic effects, known as immune-related adverse events, which have become a major hurdle in cancer care. Among these, IMC is one of the most common and severe.

Currently, our evaluation primarily relies on clinical symptom assessment, with no established endoscopic scoring system. Previous studies have shown a lack of correlation between clinical symptoms and endoscopic findings. There is a pressing need to establish an endoscopic scoring system for IMC and explore its use in guiding future SIT use compared with relying on clinical symptoms alone.

This retrospective, international, 14-center study included 674 patients who developed IMC and underwent endoscopic evaluation. Ten endoscopic features were selected by group consensus and assigned 1 point each to calculate an IMC endoscopic score (IMCES). IMCES cutoffs were chosen to maximize specificity in predicting SIT use. This specificity was compared between IMCESs, and clinical symptoms were graded according to a standardized instrument.

IMCES specificity in predicting SIT use was 82.8% with a cutoff of 4 and 87.6% with a cutoff of 5. The inclusion of ulceration as a mandatory criterion resulted in higher specificity (85.0% for a cutoff of 4 and 88.2% for a cutoff of 55). In comparison, the specificity of a Mayo endoscopic subscore of 3 was 74.6%, and specificity of clinical symptom grading was much lower at 27.4% and 12.3%, respectively. Early endoscopy was associated with timely SIT use (P < .001; r = 0.4084).

Based on our knowledge, this is the first study to devise an endoscopic scoring system to evaluate severity of IMC. The data support early endoscopic evaluation, but implementation of the described endoscopic scoring system still requires further validation in adequate sample size, ideally linked with relevant clinical endpoints and adequate follow-up in future studies.

 

 

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