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Endocrine surveillance required for patients receiving immune checkpoint inhibitors
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AUSTIN, Texas — Patients with cancer treated with immune checkpoint inhibitors are at risk for developing pituitary, thyroid and glucose metabolism dysfunctions, according to a speaker.
“Endocrine adverse events are common with the use of immune checkpoint inhibitors, and early identification and treatment are important as this may prevent discontinuation of cancer treatment,” Lauren H. Clarine, DO, an endocrinology fellow at Scripps Clinic Diabetes and Endocrinology Center in La Jolla, California, told Endocrine Today at the American Association of Clinical Endocrinologists Annual Scientific and Clinical Congress. “It is important to monitor for development of endocrine adverse events throughout therapy given the variable onset.”
Clarine and colleagues conducted a retrospective chart review of 117 patients (77 men) who received immune checkpoint inhibitors (ICH) from 2015 to 2016. The goal was to determine the incidence, presentation and management of endocrinopathies following treatment with ICH.
Eighty-three patients received anti-PD1 monoclonal antibodies, including nivolumab (Opdivo, Bristol-Myers Squibb) and pembrolizumab (Keytruda, Merck); 26 received the cytotoxic T lymphocyte antigen 4 antibody ipilimumab (Yervoy, BristolMyers Squibb); and eight received a combination of the two drug classes.
Hypophysitis was the most common endocrine disorder associated with anti-CTLA4 antibodies, while hypothyroidism was the most common endocrine disorder associated with anti-PD1 antibodies.
Overall, 37% developed some type of endocrine adverse event. Seven patients treated with ipilimumab and one treated with combination therapy developed hypophysitis. Of those, six patients were treated for central adrenal insufficiency, two for central hypothyroidism, and one for both adrenal insufficiency and hypothyroidism. None of those patients had recovery of function/complete resolution after 9 months of follow-up. An additional four patients receiving ipilimumab and one receiving anti-PD1 monoclonal antibodies developed hypothyroidism, and one patient receiving ipilimumab and one receiving combination therapy developed thyroiditis. One patient on anti-PD1 monoclonal antibodies developed type 1 diabetes.
Most of these immune-related adverse endocrine events occurred between the second and fifth infusions, but six occurred after the first and one after the 16th infusion, Clarine said.
“We recommend checking baseline pituitary hormone levels and thyroid function tests with initiation of therapy,” Clarine told Endocrine Today. “Given the frequency of development of thyroid disorders, we recommend continuing to check monthly thyroid function tests during the course of treatment. With rapid identification of endocrine adverse events, patients can be treated, to help improve their clinical course.” – by Jill Rollet
Reference:
Clarine L, et al. Abstract #716. Presented at: AACE Annual Scientific and Clinical Congress; May 3-7, 2017; AUSTIN, Texas.
Disclosures: Clarine reports no relevant financial disclosures.