Clinical characteristics of colitis induced by taxane-based chemotherapy

Ellie Chen; Hamzah Abu-Sbeih; Selvi Thirumurthi; Niharika Mallepally; Shruti Khurana; Dongguang Wei; Mehmet Altan; Van K. Morris; Dongfeng Tan; Carlos H. Barcenas; Yinghong Wang

Authors Ellie Chen, Hamzah Abu-Sbeih, Selvi Thirumurthi, Niharika Mallepally, Shruti Khurana, Dongguang Wei, Mehmet Altan, Van K. Morris, Dongfeng Tan, Carlos H. Barcenas, Yinghong Wang.

Abstract

Background Limited data are available concerning the clinical features of toxic gastrointestinal (GI) effects of taxane-based therapy. We describe the clinical, endoscopic and histologic features of taxane-induced colitis.

Methods This retrospective study included cancer patients who received taxane therapy and underwent colonoscopy for GI symptoms from 2000-2018.

Results Of the 45,527 patients who received taxane therapy during the study period, 76 (0.2%) met the inclusion criteria. Most patients (54%) received paclitaxel, 37% docetaxel, and 9% nab-paclitaxel. The median time from taxane therapy initiation to colitis symptom onset was 31 days. The median duration of colitis symptoms was 30 days. Colitis treatment comprised immunosuppressive therapy in 8 patients (11%), antibiotics in 17 (22%), antimotility agents in 18 (24%), and octreotide or somatostatin in 2 (3%). Thirty-five patients (46%) required hospitalization and seven (9%) required admission to the intensive care unit (ICU). Endoscopy revealed mucosal ulceration in 19 patients (25%), nonulcerative inflammation in 32 (42%), and normal findings in 25 (33%). Seventeen patients (22%) had features of lymphocytic colitis. One patient had spontaneous colonic perforation that required surgical intervention. Colitis symptoms recurred in 7 patients (9%) after initial improvement. Patients who received nab-paclitaxel developed GI toxicity earlier (P=0.003), required colitis-related hospitalization more frequently (P=0.005), and received intravenous fluids more frequently (P=0.025), compared with patients who received other taxanes.

Conclusions Taxane-related colitis can present with significant inflammation on colonoscopy, and in a minority of patients as microscopic colitis. Taxane-induced colitis, although uncommon, can lead to ICU admission and colonic perforation.

Keywords Taxane, paclitaxel, docetaxel, chemotherapy, colitis, diarrhea, gastrointestinal adverse events

Ann Gastroenterol 2020; 33 (1): 59-67