Refractory Colitis Following Anti-CTLA4 Antibody Therapy: Analysis of Mucosal FOXP3⁺ T Cells

Ipilimumab is a humanized antibody to CTLA4 and is used to treat cancers refractory to conventional treatment. We treated 21 patients with refractory melanoma or prostate cancer with anti-CTLA4 antibody (ipilimumab), with subsequent development of significant colitis in nine cases. Two of these nine did not respond rapidly to high-dose (2 mg kg⁻¹ day⁻¹) glucocorticoids or infliximab. They required additional immunosuppression, and one ultimately died of opportunistic infection, representing a more refractory course than has previously been described complicating ipilimumab therapy. Both patients had received radiation to the pelvis for prostate cancer less than 1 year prior to receiving ipilimumab. We performed immunohistochemical analysis of colon biopsies from ipilimumab recipients to determine if colitis correlates with depletion of intramucosal FOXP3⁺ regulatory T cells (Tregs), which normally express CTLA4. However, we found no evidence of FOXP3⁺ T cell depletion in any of the nine patients who developed colitis.