Immune checkpoint inhibitor therapy-induced hypophysitis ∼ a case series of Taiwanese patients
Journal
Journal of the Formosan Medical Association
Journal Volume
118
Journal Issue
1P3
Pages
524-529
Date Issued
2019
Author(s)
Abstract
Immune checkpoint blockade-based immunotherapy is a new modality of cancer treatment with a unique mechanism that has gained increased numbers of indication and is now used in several cancer types. However, immune-related adverse events (irAEs) emerge as a new entity of diseases involving one or multiple organ systems. irAEs could result in interruption of immunotherapy, morbidities or even death. Among various manifestations of irAEs, immune-mediated hypophysitis is rare but important, requiring prompt diagnosis and treatment to avoid life-threatening conditions. We report seven cases of immune-mediated hypophysitis in Taiwan. They suffered from various types of advanced cancer and received different regimens of immune checkpoint inhibitors. The time of onset after initiation of immunotherapy ranged from 5 to 36 weeks. All seven subjects were diagnosed of central adrenal insufficiency, while four of them had primary hypothyroidism. There was no typical finding of infiltrative hypophysitis on the pituitary MRI. There was no documented hormone recovery after diagnosis of hypophysitis, and the tumor responses to immunotherapy were variable in these seven patients. In conclusion, immune-mediated hypophysitis is often irreversible. Fortunately, it can be managed adequately with hormone replacements. Further investigations are warranted to unveil underlying mechanisms and ethnic differences to guide the solutions. ? 2018
SDGs
Other Subjects
antineoplastic agent; corticotropin; cortisone; cytotoxic T lymphocyte antigen 4 antibody; gonadotropin; hydrocortisone; levothyroxine; megestrol acetate; nivolumab; pembrolizumab; prednisolone; programmed death 1 receptor antibody; testosterone; thyrotropin; unclassified drug; antineoplastic agent; monoclonal antibody; adrenal insufficiency; adult; advanced cancer; appetite disorder; Article; body weight loss; cancer immunotherapy; case study; clinical article; clinical outcome; disease severity; fatigue; female; follow up; Graves disease; headache; hormone substitution; human; hypogonadotropic hypogonadism; hypophysitis; hypopituitarism; hypothyroidism; immunopathology; lung adenocarcinoma; male; melanoma; middle aged; monotherapy; morbidity; multiple cycle treatment; nuclear magnetic resonance imaging; rare disease; sarcomatoid carcinoma; subclinical hypothyroidism; Taiwanese; tertiary care center; transitional cell carcinoma; treatment response; uterine cervix carcinoma; Vater papilla carcinoma; aged; case report; cell cycle checkpoint; chemically induced; drug effect; endocrine disease; hypophysitis; immunotherapy; neoplasm; Taiwan; Adult; Aged; Antibodies, Monoclonal; Antineoplastic Agents; Cell Cycle Checkpoints; Endocrine System Diseases; Female; Humans; Hypophysitis; Immunotherapy; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasms; Taiwan
Publisher
Elsevier B.V.
Type
journal article