Klair, J.S., Girotra, M., Hutchins, L.F., Caradine, K.D., Aduli, F., & Garcia-Saenz-de-Sicilia, M. (2016). Ipilimumab-induced gastrointestinal toxicities: A management algorithm. Digestive Diseases and Sciences, 61, 2132–2139.
RESOURCE TYPE: Expert opinion
INCLUSION CRITERIA: Ipilimumab, colitis, perforation, metastatic melanoma
The authors developed an algorithm for caring for patients who develop diarrhea with ipilimumab treatment. Three case studies were outlined. In one study, a patient developed autoimmune colitis after an infectious diarrhea workup was negative, was treated with high-dose glucocorticoids, and improved. Another patient presented with bloody diarrhea, leukocytosis, negative stool cultures, and negative C-difficile. A colonoscopy showed severe active colitis with ulcerations that were inflammatory based on biopsy and pathology. The patient was treated with infliximab and improved. The third patient presented with nausea/vomiting, and diarrhea for one week, had negative stool and C-difficile cultures, no leukocytosis, and a normal erythrocyte sedimentation rate. Autoimmune colitis was noted on a sigmoidoscopy. The patient improved with glucocorticoids.
Case study of three patients, each with a different presentation. Two of the patients were octogenarians, and both developed more severe symptoms than the third patient, who was 51 years. Patient comorbidities were not identified.
Nurses need to carefully assess gastrointestinal symptoms in patients receiving ipilimumab to minimize complications.