Feb 8, 2020

Vitamin D Intake Is Associated With a Reduced Risk of Immunotherapy-Induced Colitis

By Eric Ramos

ORLANDO, Fla -- February 8, 2020 -- Vitamin D intake is associated with a reduced risk of immunotherapy-induced colitis, according to a study presented here at the 2020 Clinical Immuno-Oncology Symposium.

“There is a lack of predictive markers informing on the risk of colitis in patients treated with immune checkpoint inhibitors,” stated Kevin Tyan, MD, Harvard Medical School, Boston, Massachusetts. “This is the first study to report that vitamin D intake is associated with reduced risk for colitis among patients receiving immunotherapy.”

For the study, the researchers analysed data from 213 patients with melanoma who were treated at the Dana-Farber Cancer Institute in Boston between May 2011 and October 2017. Patients received pembrolizumab monotherapy, nivolumab monotherapy, ipilimumab monotherapy, or a combination of ipilimumab and nivolumab. Of the patients, 37 (17%) developed immunotherapy-induced colitis.

The odds of colitis were higher in patients treated with ipilimumab monotherapy (odds ratio [OR] = 7.48; 95% confidence interval [CI], 2.6-21.8; P = .0009) or in combination with nivolumab (OR = 3.34; 95% CI, 1.1-9.8; P = .02), compared with patients receiving pembrolizumab.

Of the patients, 66 (31%) were taking vitamin D before starting treatment. In multivariable regression analysis, vitamin D use significantly reduced the odds of developing immunotherapy-related colitis (OR = 0.35; 95% CI, 0.1-0.9; P = .01).

The findings were confirmed in a validation cohort of 169 patients with melanoma receiving the same treatments, of whom 49 (29%) developed colitis. In this cohort, the use of vitamin D significantly reduced the odds of developing colitis (OR = 0.46; 95% CI, 0.2-0.9; P = .03).

As with the original cohort, the odds of colitis in the validation cohort were higher among patients treated with ipilimumab monotherapy (OR = 2.68; 95% CI, 1.5-4.9; P = .0059) or in combination with nivolumab (OR = 3.37; 95% CI, 1.4-8.1; P = .0047), compared with patients treated with pembrolizumab.

“This finding is consistent with prior reports of prophylactic use of vitamin D in ulcerative colitis and graft versus host disease,” the authors concluded. “This observation should be validated prospectively in future studies.”

The 2020 Clinical Immuno-Oncology Symposium is co-sponsored by the American Society of Clinical Oncology (ASCO) and the Society for Immunotherapy of Cancer (SITC).

[Presentation title: Association of Vitamin D Intake With Decreased Risk of Immune Checkpoint Inhibitor-Induced Colitis. Abstract 89]

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