Karen Chunguhn Kim

All Publications

• Beyond Proton Pump Inhibitors: Evaluating Treatment Strategies for Immune-Mediated Gastroenteritis from Cancer Immunotherapy. Targeted oncology Cruz, C. C., Santos, M. J., Wali, S., Natha, C., Mortan, R., Ahuja, R., Rong, J., Gupta, T., Lee, I. J., Vemulapalli, V., Ngo, S., Takigawa, K., Varatharajalu, K., Kim, K. C., Bollin, K., Champiat, S., Shafi, M. A., Thomas, A. S., Wang, Y. 2025

  Abstract

  BACKGROUND: Immune-mediated gastroenteritis (IMG) has been commonly managed with proton pump inhibitors (PPIs), though their effectiveness is unclear. Histological analysis has shown depletion of parietal cells in the gastric mucosa during IMG, which inhibits PPI action.OBJECTIVE: Extending on a small cohort study, we assessed the role of PPIs, and alternatives such as corticosteroids, for managing IMG.PATIENTS AND METHODS: This was a retrospective study at a tertiary care cancer center, including patients with malignancy who received an immune-checkpoint inhibitor (ICI) between 2010 and 2024 and developed IMG.RESULTS: A total of 399 patients were included, of whom 281 (70.4%) received PD-1/PD-L1 inhibitors. Of these, 190 (47.6%) had exclusive IMG, and 69 (36.3%) were treated with PPIs. PPI use did not significantly impact clinical outcomes. In contrast, 156 (39.1%) received corticosteroids, showing improved clinical outcomes (75.8% vs 65%; p=0.027) and a trend towards faster symptom resolution (41.5 vs 53 days; p=0.064). Endoscopic remission was achieved in 71.1% of the steroid group and 36.7% of the non-steroid group. ICI discontinuation was more frequent with steroids (73.5% vs 50.7%; p<0.0001), as was symptom recurrence within 6 months (16.7% vs 3.6%; p<0.0001). All-cause mortality was higher in the non-steroid group (51.5% vs 41%; p=0.042), which had a shorter follow-up period (0.7 vs 1.1 years; p=0.004). Binary logistic regression showed that steroid use (OR 1.7, 95% CI 1.06-2.7; p=0.027) and ICI discontinuation (OR 1.9, 95% CI 1.1-3.0; p=0.007) were associated with clinical improvement.CONCLUSION: Our findings show faster clinical improvement and higher endoscopic remission rates with steroids, while PPIs demonstrated no significant effectiveness.

  View details for DOI 10.1007/s11523-025-01190-0

  View details for PubMedID 41381800

• Disease Outcomes in Immune-Mediated Colitis: A Study Describing Initial Endoscopic and Histologic Presentations and Treatment Options. Journal of the National Comprehensive Cancer Network : JNCCN Shatila, M., Cruz, C. C., Takigawa, K., Urias Rivera, A. C., Abdul-Baki, K., Gupta, T., Baerman, E., Lu, L., Lee, I. J., Menon, R., Sullivan, A., Vemulapalli, V., Natha, C., Salim, H., Khan, A., Varatharajalu, K., Johnson, D., Kim, K., Champiat, S., Thomas, A. S., Wang, Y. 2025; 23 (9)

  Abstract

  BACKGROUND: Immune-mediated colitis (IMC) is a toxicity associated with immune checkpoint inhibitors (ICIs) that is becoming increasingly common. Studies exploring the clinical course and outcomes of IMC have been limited to relatively small sample sizes (<200 patients). We therefore aimed to provide a comprehensive account of the clinical, endoscopic, and histologic features of IMC as well as the efficacy of IMC treatment in a representative sample.METHODS: This was a single-center retrospective study of all patients who received ICIs at our institution between January 2010 and February 2024 and subsequently developed IMC. Detailed information was collected from the electronic health record regarding patient demographics and IMC stool biomarkers, endoscopic and histologic reports, clinical symptoms and treatment, and outcomes such as clinical symptom remission, hospitalization, and mortality.RESULTS: A total of 1,151 patients were included. Patients commonly presented with diarrhea (98.3%) or abdominal pain (38.6%). Selective immunosuppressive therapy was needed in approximately 46% of patients, and 85% achieved symptom remission. Among patients with macroscopic inflammation on endoscopy, 250 (57.6%) had nonulcerative findings, whereas 139 (32.0%) had ulceration. Among patients with histologic inflammation, approximately 60% had acute inflammation, 28% had chronic inflammation, and 12% had microscopic inflammation. Infliximab was associated with a shorter time to clinical response and required fewer doses than vedolizumab, with comparable efficacy between the 2 treatments.CONCLUSIONS: Our study represents the largest to date exploring the various manifestations of IMC, along with associated treatment approaches and outcomes. We found that its features overlap with those of different inflammatory colitides. Both infliximab and vedolizumab were equally effective in achieving symptom remission; however, infliximab was associated with a shorter time to response. As the number of patients affected by IMC continues to grow, larger-scale studies will be essential to validate and expand upon these findings.

  View details for DOI 10.6004/jnccn.2025.7046

  View details for PubMedID 40930146

• The association between metformin use, immune mediated colitis and overall survival in patients treated with checkpoint inhibitor. European journal of cancer (Oxford, England : 1990) Shatila, M., Cruz, C. C., Lu, L., Abdul-Baki, K., Baerman, E., Takigawa, K., Rivera, A. U., Lee, I. J., Ngo, S., Sperling, G., Aleem, A. S., Menon, R., Sullivan, A., Vemulapalli, V., Natha, C., Gupta, T., Khan, A., Mittal, N., Coleman, G., Salim, H., Wali, S., Varatharajalu, K., Kim, K. C., Reddy, S. A., Grivas, P., Thomas, A. S., Wang, Y. 2025; 221: 115405

  Abstract

  Metformin is frequently prescribed to treat type 2 diabetes. Its primarily regulates hepatic and colonic glucose metabolism, but recent studies have suggested an anti-inflammatory effect, especially in colitis. It has been suggested that metformin may enhance immune checkpoint inhibition (ICI) efficacy for cancer treatment. Our study aims to explore the impact of metformin on ICI efficacy and the risk for colitis.This was a single center, retrospective analysis of consecutive patients at a tertiary cancer center who received ICI between 01/2010-12/2022 and developed immune-mediated colitis (IMC). Patients were screened for colitis based on stool tests, then divided into two groups depending on metformin use prior to colitis onset. We collected data on demographic and colitis clinical information including treatments, and outcomes.A total of 953 patients were included. The incidence of IMC was higher among metformin users (7.6 %) than non-metformin users (4.9 %; p < 0.01). There were no significant differences in colitis features and outcomes, except for longer hospital stay among metformin users (8 days vs 6 for non-metformin users; p = 0.03). Metformin use was associated with shorter overall survival vs non-metformin users among patients with IMC (p = 0.03).Our study is among the first to explore the impact of metformin on IMC and overall survival. We found that metformin use may be associated with higher risk of IMC. We also found an association between metformin use and shorter overall survival among patients who developed IMC. Larger studies with risk-stratified analysis are needed to validate our findings.

  View details for DOI 10.1016/j.ejca.2025.115405

  View details for PubMedID 40239400