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Vedolizumab Refractory Colitis — SCE Medical Oncology MCQ

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HardImmunotherapy & Targeted TherapyVedolizumab Refractory ColitisSCE Medical Oncology

After six cycles of nivolumab, a patient develops persistent epigastric pain, early satiety and vomiting without diarrhoea. CT is unrevealing, but gastroscopy shows diffuse erythema and biopsies show active lymphocytic gastritis; H pylori, CMV and medication causes are excluded. What is the best management?

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Correct answer: C — Hold nivolumab; use acid suppression and corticosteroids for immune gastritis

Symptomatic biopsy-confirmed immune gastritis requires checkpoint interruption, acid suppression and systemic corticosteroid, with biologic immunosuppression reserved for refractory disease. Hold nivolumab and treat immune gastritis with proton-pump inhibition initially: symptomatic biopsy-proven checkpoint gastritis usually also requires systemic corticosteroid. Hold nivolumab and treat immune gastritis with infliximab as initial therapy: infliximab is reserved for refractory disease after corticosteroid assessment. Continue nivolumab and treat immune gastritis with systemic corticosteroid: continuing the checkpoint drug is inappropriate during clinically significant active toxicity. Hold nivolumab and treat immune gastritis with vedolizumab as initial therapy: vedolizumab is a later targeted option for refractory gastrointestinal toxicity.

Reference: West of Scotland Cancer Network immune-related adverse-events guideline (Version 4.0, March 2024; review due March 2027): https://rightdecisions.scot.nhs.uk/media/b11eeh40/woscan-immunotherapy-iraes-guideline-v40.pdf; OPDIVO 10 mg/mL UK summary of product characteristics (Current UK SmPC, updated July 2026): https://www.medicines.org.uk/emc/product/6888/smpc