Treating Steroid-Refractory IEC-EC and Monitoring for Complications

In this segment the panelists, Dr. Samir Parekh and Dr. Saurabh Mehandru, of Mount Sinai in New York, take up a second case. Dr. Parekh presents a woman in her fifties with biopsy-confirmed disease who remains on high-grade non-bloody diarrhea despite weeks of steroids, requiring parenteral nutrition and electrolyte replacement as an inpatient. Dr. Mehandru walks through the gastroenterology toolbox, from cytokine-directed options including tumor necrosis factor and interleukin-23 inhibitors, to gut-selective integrin inhibitors that are well tolerated but work better against colonic than small bowel inflammation and may lack the potency to be used alone, to Janus kinase inhibitors, which he favors for this patient, induced at a higher dose and maintained at the lowest effective dose. Dr. Parekh describes the hematology perspective, including high-dose cyclophosphamide and agents familiar from graft-vs-host disease such as cyclosporine and Janus kinase inhibition, and raises the question of which Janus kinase inhibitor to select in an immunosuppressed population. Both panelists then turn to monitoring, stressing multidisciplinary care at experienced centers, an explicit risk-benefit conversation with the patient, and vigilance for infection, marrow suppression that reverses with dose reduction, thrombosis, and rare perforation. Dr. Parekh notes that repeat endoscopy has proved feasible and useful for tracking mucosal healing and titrating therapy.

This Insights Video was supported by Janssen Pharmaceutical. Content independently developed and published by OncLive.