D0418 - Fecal Microbiota Transplantation as First-Line Treatment for Immune-Mediated Colitis

Award: Presidential Poster Award

Yinghong Wang, MD, PhD¹, Krishnavathana Varatharajalu, MD², Malek Shatila, MD¹, Mathew T. Campbell, MD², Craig A. Kovitz, MD², Pavlos Msaouel, MD^2
1MD Anderson Cancer Center, Houston, TX; ²The University of Texas MD Anderson Cancer Center, Houston, TX

Introduction: Fecal microbiota transplantation (FMT) has been used to treat refractory immune-mediated colitis (IMC). However, front line FMT treatment has not been studied for IMC which could potentially reduce the complications related to high dose corticosteroids and the need for ongoing immunosuppressive biologic agents.

Case Description/Methods: We present three IMC cases who received first-line FMT on a research protocol. All patients had metastatic renal cell cancer and received immune checkpoint inhibitors (ICI) which lead to IMC. Clinical symptoms severity was measured by CTCAE, and endoscopy colitis severity was graded by Mayo endoscopy score.

Patient A is a woman in 50s with grade 3 diarrhea and calprotectin >1000mcg/gm. Colonoscopy revealed Mayo 3 colitis. Sustained clinical remission was achieved for 13 months since day 1 after FMT. Calprotectin returned to baseline within 2 months with dramatic mucosal healing within 2 months (Mayo 1) on repeat scope despite re-challenge with 2 doses of nivolumab afterwards. Most recent staging 2 months showed favorable cancer response.

Patient B is a man in 70s with grade 3 diarrhea and grade 2 colitis, with initial colonoscopy showing Mayo 3 colitis and calprotectin 244mcg/gm. He had refractory diarrhea and colitis symptom despite FMT leading to hospitalization. Subsequently he was started on steroid and vedolizumab after which his colitis was in complete remission for 10 months with histological resolution. Last staging showed stable cancer.

Patient C is a man in 70s with end stage renal disease on hemodialysis and heart failure who presented with grade 3 diarrhea and grade 2 colitis and calprotectin 718mcg/gm. He had Mayo 3 colitis on initial colonoscopy and achieved partial symptom response from FMT with less incontinence and better stool consistency within one month post-FMT. Second FMT was planned, however he developed worsening heart failure with hypotension, poor tolerance to hemodialysis, and died from multi-organ failure 1.5 months later unrelated to FMT.

Discussion: This is the first study investigating the efficacy and safety of first-line FMT in treating IMC. It has demonstrated favorable safety profile and promising signal of IMC improvement. Additional investigation in larger patient cohorts is warranted to further assess the utility of FMT as a first-line treatment for IMC and its impact on cancer outcomes.


Disclosures:


Yinghong Wang, MD, PhD¹, Krishnavathana Varatharajalu, MD², Malek Shatila, MD¹, Mathew T. Campbell, MD², Craig A. Kovitz, MD², Pavlos Msaouel, MD². D0418 - Fecal Microbiota Transplantation as First-Line Treatment for Immune-Mediated Colitis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.