At the 🔀of oncology & IBD: Let’s talk immunotherapy-induced enterocolitis (ICI/IMC) 📌#Back2Basics April14 📌Convo David Faleck April28 🆓#CME 👉🏽bit.ly/MNIBD24-25 🗳️PreB2B polls👇🏽 Support by educ grant AbbVie JanssenUS Takeda 📍Where are you in your 🩺

#PreB2B #IBDPoll1️⃣ 🆓#CME👉🏽 bit.ly/ICIsB2Bpre 57y/o w metastatic melanoma started ipilimumab + nivolumab 7 weeks ago. Now in ER w 4 days of non-bloody diarrhea (7 loose BM/day), abdo pain, malaise. Stool studies pending, CT scan: pancolitis. What is the most likely dx?

#PreB2B #IBDPoll2️⃣ 🆓#CME👉🏽 bit.ly/ICIsB2Bpre This pt is admitted 🏥, stool neg for Cdiff, culture is pending; Flex sig on day 2: erythema + superficial ulcers, biopsies pending. No improvement on IV Solumedrol 1mg/kg/d x 3 days What’s next ?

#MondayNightIBD 1/🔹Immune checkpoints like CTLA-4, PD-1,PD-L1 AND LAG-3 suppress T-cell activity -> cancer cells evade immune anti-tumor response 🔹IC inhibitors (ICI)➡️ Reactivation T-cell response to CA➡️ improved survival across many cancers. #MNIBD #Back2Basics #MedTwitter

#MondayNightIBD elizabeth buchbinder Jamie Chaft GREGORY W FISCHER, MD margaret barton-burke Myriam Chalabi Timothy Chan Keith Siau Arndt Vogel Ryan Nipp, MD, MPH, MBA, FASCO Carl Kay, MD 2/⚠️T cells activated by ICI can cross-react w normal tissue -> Autoimmune-like phenomena called immune-related adverse events (irAEs) 💩GI, skin, liver, lungs, & endocrine systems are most commonly affected ⌛️ Organ specific irAEs occur at different time from ICI initiation

#MondayNightIBD elizabeth buchbinder Jamie Chaft GREGORY W FISCHER, MD margaret barton-burke Myriam Chalabi Timothy Chan Keith Siau Arndt Vogel Ryan Nipp, MD, MPH, MBA, FASCO Carl Kay, MD Ugo Iroku MD Amir Ghaffari Amy Bugwadia, MS Gastrolegacy Muddasir Ayaz Sophie Restellini Mary Barbara Kerri Glassner Sang Hyoung Park Megan Lutz 3/It's important to recognize that ICI can cause diarrhea without colitis 🔹% ICI-diarrhea > %ICI-colitis ⚠️ Confirm colitis vs simple diarrhea to ❌Avoid over-use of steroids ❌Avoid missing colitis dx: ⚠️Earlier scope & treatment= better prognosis

#MondayNightIBD elizabeth buchbinder Jamie Chaft GREGORY W FISCHER, MD margaret barton-burke Myriam Chalabi Timothy Chan Keith Siau Arndt Vogel Ryan Nipp, MD, MPH, MBA, FASCO Carl Kay, MD Ugo Iroku MD Amir Ghaffari Amy Bugwadia, MS Gastrolegacy Muddasir Ayaz Sophie Restellini Mary Barbara Kerri Glassner Sang Hyoung Park Megan Lutz Jan Král Nabil Quraishi Rashid Lui 雷諾信 Javier A. Villafuerte Gálvez Harry Sokol Evan Lipson Deepak Gopal Ryan Smith Jean-Paul Achkar Ari Garber MD, EdD 4/ CTCAE grading of ICI-diarrhea & ICI-colitis severity: ⬆️in # of BM/day over baseline (or⬆️ostomy output) 🔹Abdo pain, blood in stool 🔹Fever, HE instability, 🏥, peritoneal signs

#MondayNightIBD elizabeth buchbinder Jamie Chaft GREGORY W FISCHER, MD margaret barton-burke Myriam Chalabi Timothy Chan Keith Siau Arndt Vogel Ryan Nipp, MD, MPH, MBA, FASCO Carl Kay, MD Ugo Iroku MD Amir Ghaffari Amy Bugwadia, MS Gastrolegacy Muddasir Ayaz Sophie Restellini Mary Barbara Kerri Glassner Sang Hyoung Park Megan Lutz Jan Král Nabil Quraishi Rashid Lui 雷諾信 Javier A. Villafuerte Gálvez Harry Sokol Evan Lipson Deepak Gopal Ryan Smith Jean-Paul Achkar Ari Garber MD, EdD Shrinivas Bishu Reezwana C, MD, FACG Tanvi Dhere,MD Waqqas Afif, MD Robert Battat MD Jami Kinnucan, MD, FACG, AGAF, FCCF Nisha Loganantharaj Seb Jeffrey McCurdy MD PhD Kajali Mishra 5/ ICI-induced enterocolitis: 🔹Incidence & interval between starting ICI & developing colitis vary by agent ⬆️risk w ⬆️ICI dose ⬆️risk & earlier onset w ICI combo vs monotherapy ⚠️ Can progress rapidly -> complications: perforation, toxic megacolon, Intra-abdominal abscess

#MondayNightIBD elizabeth buchbinder Jamie Chaft GREGORY W FISCHER, MD margaret barton-burke Myriam Chalabi Timothy Chan Keith Siau Arndt Vogel Ryan Nipp, MD, MPH, MBA, FASCO Carl Kay, MD Ugo Iroku MD Amir Ghaffari Amy Bugwadia, MS Gastrolegacy Muddasir Ayaz Sophie Restellini Mary Barbara Kerri Glassner Sang Hyoung Park Megan Lutz Jan Král Nabil Quraishi Rashid Lui 雷諾信 Javier A. Villafuerte Gálvez Harry Sokol Evan Lipson Deepak Gopal Ryan Smith Jean-Paul Achkar Ari Garber MD, EdD Shrinivas Bishu Reezwana C, MD, FACG Tanvi Dhere,MD Waqqas Afif, MD Robert Battat MD Jami Kinnucan, MD, FACG, AGAF, FCCF Nisha Loganantharaj Seb Jeffrey McCurdy MD PhD Kajali Mishra Vincent Cheung Andrew Protheroe PaulKlenermanLab 𝚂𝚊𝚛𝚊𝚑 𝚂𝚊𝚜𝚜𝚘𝚗 Kathryn Bollin Pauline Funchain Jarushka Naidoo Kelly (Faltus) Brassil, PhD, RN Tauseef Ali MD, FACG AGAF FACP 6/ Initial work-up for suspected ICI colitis includes: 🧪 CBC, CMP, CRP 🦠 Stool studies: C. diff, culture, Giardia 🧫 Fecal calprotectin/lactoferrin 🔦Scope: at least Flex sig, prefer EGD/CLN w bx 🔍 TB test, hepatitis B screen before starting biologic

#MondayNightIBD elizabeth buchbinder Jamie Chaft GREGORY W FISCHER, MD margaret barton-burke Myriam Chalabi Timothy Chan Keith Siau Arndt Vogel Ryan Nipp, MD, MPH, MBA, FASCO Carl Kay, MD Ugo Iroku MD Amir Ghaffari Amy Bugwadia, MS Gastrolegacy Muddasir Ayaz Sophie Restellini Mary Barbara Kerri Glassner Sang Hyoung Park Megan Lutz Jan Král Nabil Quraishi Rashid Lui 雷諾信 Javier A. Villafuerte Gálvez Harry Sokol Evan Lipson Deepak Gopal Ryan Smith Jean-Paul Achkar Ari Garber MD, EdD Shrinivas Bishu Reezwana C, MD, FACG Tanvi Dhere,MD Waqqas Afif, MD Robert Battat MD Jami Kinnucan, MD, FACG, AGAF, FCCF Nisha Loganantharaj Seb Jeffrey McCurdy MD PhD Kajali Mishra Vincent Cheung Andrew Protheroe PaulKlenermanLab 𝚂𝚊𝚛𝚊𝚑 𝚂𝚊𝚜𝚜𝚘𝚗 Kathryn Bollin Pauline Funchain Jarushka Naidoo Kelly (Faltus) Brassil, PhD, RN Tauseef Ali MD, FACG AGAF FACP 7/ Endoscopic🔦findings in ICI colitis range from normal to IBD-like 🔬Histo: destructive pattern w crypt/epithelial apoptosis; acute/chronic inflam, cryptitis & crypt architecture distortion 📌Can mimic microscopic colitis or celiac ⚠️Always biopsy—even if mucosa looks normal

🛎️ #GI #Oncology Join the convo w David Faleck Aline Charabaty, MD, FACG, AGAF What do you do when a pt w #IBD needs immunotherapy (immune checkpoint inhibitors) for a malignancy ? 🗳️#IBDPoll👇🏽, RT, share your 💬 w us, 🔖 your fav experts ! 🆓#CME 👉🏽bit.ly/MNIBD24-2

#MondayNightIBD Aline Charabaty, MD, FACG, AGAF 55M w/ UC x30y. Prior 5-ASA, 6MP. On IFX 5 mg/kg q8w x5y. Mild UC sx before infusions. 🔦Last scope 1y ago: Mayo 0. Now FCP 141, IFX level 3. New dx: metastatic melanoma → onc is starting nivolumab. What do you recommend for his UC?

🤦‍♀️Missed yesterdays #TumorBoardTuesday #BladderCancer discussion w/🌟Yüksel Ürün & Emre Yekedüz? 🪩No stress, we saved the🔑parts for you 📖View the archive 👉bonumce.com/mibc-convo-arc… 🏆then claim #CME #MuscleInvasiveBladderCancer #TumorBoardTuesday Mike Pishvaian