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C. difficile and ICI Colitis — SCE Medical Oncology MCQ

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ModerateImmunotherapy & Targeted TherapyC. difficile and ICI ColitisSCE Medical Oncology

A patient on ICI develops suspected immune-related colitis. Stool PCR returns positive for Clostridioides difficile toxin. How does this change management?

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Correct answer: B — C. difficile infection and ICI colitis can coexist — treat C. difficile with oral vancomycin simultaneously with ICI hold; if symptoms persist after C. difficile treatment, immune-related colitis should be suspected and corticosteroids considered

E. difficile and immune-related colitis can coexist and must both be addressed. C. difficile should be treated with oral vancomycin (or fidaxomicin) per NICE guidelines. ICI should be held. If diarrhoea persists after completion of C. difficile treatment with documented microbiological clearance, immune-mediated colitis should be suspected and corticosteroids initiated. Infliximab should only be given after C. difficile has been adequately treated. This dual pathology is increasingly recognised in ICI-treated patients.

Reference: ESMO 2024 irAE Management; NICE C. difficile Guidelines