{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:11:05Z","timestamp":1760145065410,"version":"build-2065373602"},"reference-count":40,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2024,6,18]],"date-time":"2024-06-18T00:00:00Z","timestamp":1718668800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health (NIH)","doi-asserted-by":"publisher","award":["5U10CA035421"],"award-info":[{"award-number":["5U10CA035421"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Immune-mediated diarrhea represents a serious complication of checkpoint inhibitor therapy, especially following ipilimumab-based treatment. Efficient diagnosis and control of diarrhea remains an ongoing challenge. We developed an accelerated management paradigm for patients with ipilimumab-induced diarrhea. Patients who developed significant diarrhea (&gt;five loose stools\/day) were presumed to be developing immune colitis. Therapy was interrupted and patients were treated with a methylprednisolone dose pack. If diarrhea was not completely resolved, high-dose steroids and infliximab were promptly added. Only non-responding patients underwent further evaluation for infection or other causes of diarrhea. A total of 242 patients were treated with ipilimumab-based regimens. Forty-six developed significant diarrhea (19%) and thirty-four (74.4%) had a rapid resolution of diarrhea following glucocorticosteroid and infliximab treatment. The median time to resolution of diarrhea was only 8.5 \u00b1 16.4 days. Accelerated treatment for presumed immune-mediated diarrhea resulted in the rapid control of symptoms in the majority of patients. There were no intestinal complications or deaths. Immunosuppressive therapy for diarrhea did not appear to decrease the remission rate or survival. After the control of diarrhea, most patients were able to continue their planned immunotherapy. Further testing in 11\/46 patients with unresponsive diarrhea revealed additional diagnoses, allowing their treatment to be adjusted.<\/jats:p>","DOI":"10.3390\/curroncol31060260","type":"journal-article","created":{"date-parts":[[2024,6,18]],"date-time":"2024-06-18T03:42:06Z","timestamp":1718682126000},"page":"3529-3545","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcome of an Accelerated Treatment Algorithm for Patients Developing Diarrhea as a Complication of Ipilimumab-Based Cancer Immunotherapy in a Community Practice"],"prefix":"10.3390","volume":"31","author":[{"given":"Clarice","family":"Ho","sequence":"first","affiliation":[{"name":"School of Medicine, University of Nevada, Reno, NV 89557, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0713-914X","authenticated-orcid":false,"given":"Wolfram","family":"Samlowski","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Nevada, Reno, NV 89557, USA"},{"name":"Comprehensive Cancer Centers of Nevada, Las Vegas, NV 89148, USA"},{"name":"Kerkorian School of Medicine, University of Nevada Las Vegas (UNLV), Las Vegas, NV 89106, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1200\/JCO.2000.18.1.158","article-title":"Randomized phase III study of temozolomide versus dacarbazine in the treatment of patients with advanced metastatic malignant melanoma","volume":"18","author":"Middleton","year":"2000","journal-title":"J. Clin. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1200\/JCO.2007.12.7837","article-title":"Meta-analysis of phase II cooperative group trials in metastatic stage IV melanoma to determine progression-free and overall survival benchmarks for future phase II trials","volume":"26","author":"Korn","year":"2008","journal-title":"J. Clin. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1056\/NEJMoa1003466","article-title":"Improved Survival with Ipilimumab in Patients with Metastatic Melanoma","volume":"363","author":"Hodi","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1200\/JCO.2014.56.2736","article-title":"Pooled Analysis of Long-Term Survival Data From Phase II and Phase III Trials of Ipilimumab in Unresectable or Metastatic Melanoma","volume":"33","author":"Schadendorf","year":"2015","journal-title":"J. Clin. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1056\/NEJMoa1305133","article-title":"Safety and tumor responses with lambrolizumab (anti-PD-1) in melanoma","volume":"369","author":"Hamid","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1200\/JCO.2013.53.0105","article-title":"Survival, durable tumor remission, and long-term safety in patients with advanced melanoma receiving nivolumab","volume":"32","author":"Topalian","year":"2014","journal-title":"J. Clin. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1093\/annonc\/mdz011","article-title":"Five-year survival outcomes for patients with advanced melanoma treated with pembrolizumab in KEYNOTE-001","volume":"30","author":"Hamid","year":"2019","journal-title":"Ann. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1056\/NEJMoa1910836","article-title":"Five-Year Survival with Combined Nivolumab and Ipilimumab in Advanced Melanoma","volume":"381","author":"Larkin","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1200\/JCO.21.02229","article-title":"Long-Term Outcomes with Nivolumab Plus Ipilimumab or Nivolumab Alone Versus Ipilimumab in Patients with Advanced Melanoma","volume":"40","author":"Wolchok","year":"2021","journal-title":"J. Clin. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1200\/JCO.22.01763","article-title":"Combination Dabrafenib and Trametinib Versus Combination Nivolumab and Ipilimumab for Patients with Advanced BRAF-Mutant Melanoma: The DREAMseq Trial-ECOG-ACRIN EA6134","volume":"41","author":"Atkins","year":"2022","journal-title":"J. Clin. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1126\/science.aaa8172","article-title":"The future of immune checkpoint therapy","volume":"348","author":"Sharma","year":"2015","journal-title":"Science"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1038\/s41571-019-0218-0","article-title":"Adverse effects of immune-checkpoint inhibitors: Epidemiology, management and surveillance","volume":"16","author":"Martins","year":"2019","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.ejca.2015.11.016","article-title":"Immune-related adverse events with immune checkpoint blockade: A comprehensive review","volume":"54","author":"Michot","year":"2016","journal-title":"Eur. J. Cancer"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"49","DOI":"10.3389\/fphar.2017.00049","article-title":"Current Diagnosis and Management of Immune Related Adverse Events (irAEs) Induced by Immune Checkpoint Inhibitor Therapy","volume":"8","author":"Kumar","year":"2017","journal-title":"Front. Pharmacol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"387","DOI":"10.6004\/jnccn.2022.0020","article-title":"Management of Immunotherapy-Related Toxicities, Version 1.2022, NCCN Clinical Practice Guidelines in Oncology","volume":"20","author":"Thompson","year":"2022","journal-title":"J. Natl. Compr. Canc. Netw."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.3389\/fimmu.2017.01547","article-title":"Checkpoint Blockade Toxicity and Immune Homeostasis in the Gastrointestinal Tract","volume":"8","author":"Dougan","year":"2017","journal-title":"Front. Immunol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2006","DOI":"10.1056\/NEJMoa1414428","article-title":"Nivolumab and ipilimumab versus ipilimumab in untreated melanoma","volume":"372","author":"Postow","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Asher, N., Ben-Betzalel, G., Lev-Ari, S., Shapira-Frommer, R., Steinberg-Silman, Y., Gochman, N., Schachter, J., Meirson, T., and Markel, G. (2020). Real World Outcomes of Ipilimumab and Nivolumab in Patients with Metastatic Melanoma. Cancers, 12.","DOI":"10.3390\/cancers12082329"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1634\/theoncologist.2018-0304","article-title":"Workup and Management of Immune-Mediated Colitis in Patients Treated with Immune Checkpoint Inhibitors","volume":"25","author":"Singh","year":"2020","journal-title":"Oncologist"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1712","DOI":"10.1093\/annonc\/mdq013","article-title":"Efficacy and safety of ipilimumab monotherapy in patients with pretreated advanced melanoma: A multicenter single-arm phase II study","volume":"21","author":"Maio","year":"2010","journal-title":"Ann. Oncol. Off. J. Eur. Soc. Med. Oncol.\/ESMO"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1097\/MCG.0b013e31828f1d51","article-title":"Ipilimumab-induced perforating colitis","volume":"47","author":"Mitchell","year":"2013","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_22","first-page":"e1182","article-title":"Ipilimumab as a Cause of Severe Pan-Colitis and Colonic Perforation","volume":"9","author":"Shah","year":"2017","journal-title":"Cureus"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1080\/13696998.2019.1696349","article-title":"Hospitalization and emergency department utilization in patients with advanced melanoma receiving pembrolizumab versus ipilimumab plus nivolumab in US academic centers","volume":"23","author":"Joseph","year":"2020","journal-title":"J. Med. Econ."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1721","DOI":"10.1001\/jamaoncol.2018.3923","article-title":"Fatal Toxic Effects Associated With Immune Checkpoint Inhibitors: A Systematic Review and Meta-analysis","volume":"4","author":"Wang","year":"2018","journal-title":"JAMA Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"405","DOI":"10.12998\/wjcc.v7.i4.405","article-title":"Immune checkpoint inhibitor-induced colitis: A comprehensive review","volume":"7","author":"Som","year":"2019","journal-title":"World J. Clin. Cases"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.ejca.2008.10.026","article-title":"New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1)","volume":"45","author":"Eisenhauer","year":"2009","journal-title":"Eur. J. Cancer"},{"key":"ref_27","unstructured":"U.S. Department of Health and Human Services, National Institutes of Health, and National Cancer Institute (2024, June 12). Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0, Available online: https:\/\/ctep.cancer.gov\/protocoldevelopment\/electronic_applications\/docs\/CTCAE_v5_Quick_Reference_8.5x11.pdf."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1200\/JCO.18.01998","article-title":"Evaluation of Two Dosing Regimens for Nivolumab in Combination with Ipilimumab in Patients with Advanced Melanoma: Results from the Phase IIIb\/IV CheckMate 511 Trial","volume":"37","author":"Lebbe","year":"2019","journal-title":"J. Clin. Oncol."},{"key":"ref_29","first-page":"795","article-title":"Cautious Addition of MEK Inhibitors to PD-1 Antibody Treatment in Patients with NRAS or NF1 Mutant Metastatic Melanoma Failing Initial Immunotherapy","volume":"7","author":"Hilts","year":"2022","journal-title":"Ann. Case Rep."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Samlowski, W., and Adajar, C. (2021). Cautious addition of targeted therapy to PD-1 inhibitors after initial progression of BRAF mutant metastatic melanoma on checkpoint inhibitor therapy. BMC Cancer, 21.","DOI":"10.1186\/s12885-021-08906-1"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1080\/01621459.1958.10501452","article-title":"Nonparametric Estimation from Incomplete Observations","volume":"53","author":"Kaplan","year":"1958","journal-title":"J. Am. Stat. Assoc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1136\/bmj.328.7447.1073","article-title":"The logrank test","volume":"328","author":"Bland","year":"2004","journal-title":"BMJ"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"387","DOI":"10.6004\/jnccn.2022.0020","article-title":"Management of Immunotherapy-Related Toxicities, Version 1.2024, NCCN Clinical Practice Guidelines in Oncology","volume":"20","author":"Thompson","year":"2024","journal-title":"J. Natl. Compr. Canc. Netw."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1384","DOI":"10.1053\/j.gastro.2020.08.063","article-title":"AGA Clinical Practice Update on Diagnosis and Management of Immune Checkpoint Inhibitor Colitis and Hepatitis: Expert Review","volume":"160","author":"Dougan","year":"2021","journal-title":"Gastroenterology"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Losurdo, G., Angelillo, D., Favia, N., Sergi, M.C., Di Leo, A., Triggiano, G., and Tucci, M. (2023). Checkpoint Inhibitor-Induced Colitis: An Update. Biomedicines, 11.","DOI":"10.3390\/biomedicines11051496"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"800879","DOI":"10.3389\/fimmu.2021.800879","article-title":"Immune Checkpoint Inhibitor-Associated Colitis: From Mechanism to Management","volume":"12","author":"Tang","year":"2021","journal-title":"Front. Immunol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1186\/s40425-019-0711-0","article-title":"Concurrent therapy with immune checkpoint inhibitors and TNFalpha blockade in patients with gastrointestinal immune-related adverse events","volume":"7","author":"Badran","year":"2019","journal-title":"J. Immunother. Cancer"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1001\/jamaoncol.2017.2391","article-title":"Measuring Toxic Effects and Time to Treatment Failure for Nivolumab Plus Ipilimumab in Melanoma","volume":"4","author":"Shoushtari","year":"2018","journal-title":"JAMA Oncol."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Panning, A., Samlowski, W., and Allred, G. (2023). Lack of Influence of Non-Overlapping Mutations in BRAF, NRAS, or NF1 on 12-Month Best Objective Response and Long-Term Survival after Checkpoint Inhibitor-Based Treatment for Metastatic Melanoma. Cancers, 15.","DOI":"10.3390\/cancers15133527"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"102134","DOI":"10.1016\/j.ctrv.2020.102134","article-title":"Association between immune-related side effects and efficacy and benefit of immune checkpoint inhibitors\u2014A systematic review and meta-analysis","volume":"92","author":"Hussaini","year":"2021","journal-title":"Cancer Treat. Rev."}],"container-title":["Current Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1718-7729\/31\/6\/260\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:00:20Z","timestamp":1760108420000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1718-7729\/31\/6\/260"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,18]]},"references-count":40,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,6]]}},"alternative-id":["curroncol31060260"],"URL":"https:\/\/doi.org\/10.3390\/curroncol31060260","relation":{},"ISSN":["1718-7729"],"issn-type":[{"type":"electronic","value":"1718-7729"}],"subject":[],"published":{"date-parts":[[2024,6,18]]}}}