Severe immune-mediated colitis due to Nivolumab-Ipilimumab: a case report

Abstract

Immune checkpoint inhibitors (ICIs) are used as a treatment of choice for various types of cancer. The combination of nivolumab and ipilimumab induces immune activation, enhancing the antitumor response with excellent results in the treatment of metastatic melanoma. However, multiple adverse reactions associated with their use have been reported, with the digestive system being one of the main systems affected.
Mild immune-mediated toxicity (grades 1-2) is relatively common, occurring in 16% to 25% of patients. In contrast, more severe forms (grades 3-5) are much rarer, with a frequency of less than 5%. The frequency of severe adverse events, however, increases when these two drugs are combined.
We present the case of a patient with a history of stage IV melanoma undergoing combination therapy with nivolumab plus ipilimumab who developed a severe immune-mediated colitis. Timely recognition of this complication in patients exposed to ICIs is crucial, as delayed diagnosis and failure to initiate early treatment are associated with higher hospitalization rates and potentially life-threatening complications.