Can FMT Eliminate Colitis Caused by Immunotherapy?

A new study conducted by researchers at The University of Texas MD Anderson Cancer Center suggests transplanting gut bacteria from healthy donors can significantly reduce severe colitis caused by immunotherapy.

Immunotherapies, or immune checkpoint inhibitors, have generated durable responses among patients with various cancers. However, colitis is the second most common adverse event caused by the inhibitors. 

Yinghong Wang, MD, PhD, director of Medication Induced Colitis and Enteritis at The University of Texas MD Anderson Cancer Center, and colleagues sought to determine the potential of fecal microbiota transplant (FMT) as an alternative, therapy for patients with refractory immunotherapy-induced colitis. 

The study included two patients treated at MD Anderson Cancer Center between June 2017 and January 2018. Both patients underwent FMT and had resolved colitis after completion of transplant. Gastroenterology Consultant caught up with Dr Wang about her research.
 
Gastroenterology Consultant: How did your study come about?

Yinghong Wang: This is a new breakthrough for a very challenging gastrointestinal toxicity that is related to the new cancer immunotherapy. The limitation of the current available treatments motivated our team of researchers and clinicians to explore alternative options to help patients to resume their cancer treatment and keep their colitis in remission as soon as possible.
 
GASTRO CON: Inflammation of the colon occurs in up to 40% of individuals who receive treatment with an immune checkpoint inhibitor for cancer. What are the current options for managing this in patients?

YW: The current treatment options are limited to immunosuppressants (corticosteroids, or non-steroidal immunosuppressants e.g. TNF-α blocker, and α4β7 integrin blocker). However, these immunosuppressants could potentially cause their own associated side effects and also potentially counteract with immunotherapies for their anti-tumor effect. Most importantly, there are cases that are refractory to immunosuppressants that have no alternative treatment options left before this study came out.
 
GASTRO CON: Both patients in your study experienced complete resolution of their colitis following treatment with FMT. Were you surprised by the findings?

YW: Yes, as this is a novel study, we could not predict what will happen. It turns out to be a miracle effect for them.
 
GASTRO CON: One patient’s colitis resolved within two weeks following a single FMT treatment, whereas the second patient experienced complete recovery after a second FMT. Why do you think one patient required another FMT treatment?

YW: The reason for this observation is unclear. However, it could be related to several factors, such as the type of immune checkpoint inhibitors the patient previously was exposed to, the type of cancer, severity of the colitis, baseline stool microbiome pattern from patient, and the donor’s stool microbiome.
 
GASTRO CON: What is the next step in your research?

YW: We will launch larger scale clinical trials by offering fecal transplant to more patients who will benefit from this treatment.

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Reference: 

Wang Y, Wiesnoski DH, Helmink BA, et al. Fecal microbiota transplantation for refractory immune checkpoint inhibitor-associated colitis [published online November 12, 2018]. Nat Med. https://www.nature.com/articles/s41591-018-0238-9.