University of Texas Medical Branch at Galveston Galveston, TX
Sharada Wali, MBBS, MPH1, Kian Abdul-Baki, DO2, Nina Quirk, MD, MS3, Humberto R.. Nieves-Jiménez, MD4, Pooja Prasad, MD5, Sidra Naz, MD, MPH1, Maria Julia M. N.. Santos, MD6, Carolina Cruz, MD1, Krishnavathana Varatharajalu, MD6, Mianen Sun, PhD1, Jeff Jin, 1, Yinghong Wang, MD, PhD, MS1 1University of Texas MD Anderson Cancer Center, Houston, TX; 2University of Texas Medical Branch at Galveston, Galveston, TX; 3University of Texas Health Sciences Center in Houston, Houston, TX; 4Baylor College of Medicine / MD Anderson Cancer Center, Houston, TX; 5Baylor College of Medicine, Houston, TX; 6MD Anderson Cancer Center, Houston, TX Introduction: Immune-related adverse events (irAEs) associated with immune-checkpoint inhibitors (ICIs) can affect various organ systems. Gastrointestinal side effects are the most common. Clustering of irAEs refers to grouping AEs based on affected organs, which may impact the patient’s overall outcome. Our study aimed to compare the management and outcomes between patients with IMC alone and those who developed IMC and non-GI irAEs. Methods: This was a single-center, retrospective review. Natural language processing data (NLP) was used to identify keywords from patient electronic health records (EHRs) to screen for irAEs from 2019-2024. GI irAEs were identified by clinical context, stool inflammatory markers, colonoscopy, and histology findings. Non-GI irAEs were reported after ICI initiation within the study window. Variables included but were not limited to patient demographic information, cancer type, ICI regimen, symptoms, lab results, stool tests, treatment, and survival outcomes. SPSS 26.0 was used to analyze the data. Results: A total of 437 patients with GI irAEs were included, with 251 patients having other irAEs. The most common were endocrine (25.7%), followed by lung (15.5%), and skin (14.2%). Among them, 121 (48.2%) had two organ irAEs, and 27 (10.8%) had three. Immunosuppressive therapy was used in approximately 50-60% of cases with two organ systems affected, but 100% among patients with three organ irAEs. Biologic therapy was required only among 6 patients (2.4%) for non-Gi irAEs, but 50.3% for GI irAEs alone. Comparatively, CTLA-4-based regimens were associated with more multi-organ irAEs. The survival of patients with multiple irAEs was comparable to patients with colitis alone (2.312 [CI 2.064-2.708] and 2.219 [CI 2.102-2.523]). Discussion: Our study described the clustering pattern of non-GI irAEs associated with GI irAEs and management strategies. While corticosteroid and biologic regimens were utilized in the majority of patients with GI irAE alone, for non-GI irAEs, steroids were the mainstay of management, with biologics only required in 2.4% of patients. Multi-organ irAEs alongside GI irAEs don’t appear to further impact the long-term survival compared to GI irAEs alone.
Figure: Pie chart demonstrating common irAE clusters and percentage of cases that required steroid and biologic therapy.
Figure: Table demonstrating common irAE clusters with a breakdown of cases that required steroid or biologic therapy.
Disclosures: Sharada Wali indicated no relevant financial relationships. Kian Abdul-Baki indicated no relevant financial relationships. Nina Quirk indicated no relevant financial relationships. Humberto Nieves-Jiménez indicated no relevant financial relationships. Pooja Prasad indicated no relevant financial relationships. Sidra Naz indicated no relevant financial relationships. Maria Julia Santos indicated no relevant financial relationships. Carolina Cruz indicated no relevant financial relationships. Krishnavathana Varatharajalu indicated no relevant financial relationships. Mianen Sun indicated no relevant financial relationships. Jeff Jin indicated no relevant financial relationships. Yinghong Wang indicated no relevant financial relationships.
Sharada Wali, MBBS, MPH1, Kian Abdul-Baki, DO2, Nina Quirk, MD, MS3, Humberto R.. Nieves-Jiménez, MD4, Pooja Prasad, MD5, Sidra Naz, MD, MPH1, Maria Julia M. N.. Santos, MD6, Carolina Cruz, MD1, Krishnavathana Varatharajalu, MD6, Mianen Sun, PhD1, Jeff Jin, 1, Yinghong Wang, MD, PhD, MS1. P4552 - Comparative Survival Outcomes and Cluster Effect of Immune-Mediated Colitis and Multisystem Immune-Related Adverse Events in Patients Receiving Immune-Checkpoint Inhibitors, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
