Reduced Tumor Size of Untreated Papillary Thyroid Carcinoma After Immune Checkpoint Inhibitor–Induced Thyroiditis
Background/Objective: Immune checkpoint inhibitors (CPIs) activate antitumoral immune responses and are used to treat multiple types of primary and metastatic malignancies. Thyroid dysfunction is a known immune-related adverse event of CPI therapy. There are few data on the effect of CPI and CPI-ind...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-09-01
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| Series: | AACE Clinical Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2376060523001153 |
| _version_ | 1797686809277235200 |
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| author | Dennis H. Chen, MD Heinz-Josef Lenz, MD Melissa G. Lechner, MD/PhD Trevor E. Angell, MD |
| author_facet | Dennis H. Chen, MD Heinz-Josef Lenz, MD Melissa G. Lechner, MD/PhD Trevor E. Angell, MD |
| author_sort | Dennis H. Chen, MD |
| collection | DOAJ |
| description | Background/Objective: Immune checkpoint inhibitors (CPIs) activate antitumoral immune responses and are used to treat multiple types of primary and metastatic malignancies. Thyroid dysfunction is a known immune-related adverse event of CPI therapy. There are few data on the effect of CPI and CPI-induced thyroiditis on primary papillary thyroid carcinoma (PTC). We present a patient who developed CPI-induced thyroiditis during treatment for a nonthyroid malignancy and subsequent regression of a coexisting untreated primary PTC. Case Report: A 49-year-old man with metastatic colon adenocarcinoma was found to have a large right thyroid nodule with biopsy confirmation of PTC. He did not have compressive symptoms or evidence of metastatic PTC. Resection was not performed because of colon cancer therapy. Treatment with CPI (ezabenlimab, an anti–programmed cell death protein 1 antibody) was initiated for the treatment of colon cancer. Four months after the initiation of CPI therapy, testing showed thyroid–stimulating hormone and free thyroxine levels of 174.9 (0.3-4.0 mIU/L) and 0.67 (0.93-1.70 ng/dL), respectively, consistent with CPI-induced hypothyroidism. Levothyroxine therapy was initiated. Repeat imaging 3 months later demonstrated a decrease in the tumor size to 4.1 × 4.9 × 4.2 cm (calculated volume change, −8.3% from baseline). At the last imaging, 1 year after the onset of CPI-induced thyroiditis, the PTC continued to decrease in size and measured 2.9 × 3.9 × 3.2 cm (volume change, −60.7% from baseline). Discussion: CPI-induced thyroiditis suggests the development of an immune response against thyroid tissue and may reflect a similar increased immune response against PTC cells leading to tumor regression in this case. Conclusion: Further research to assess the immunologic mechanism underlying this association is warranted to potentially develop improved immunotherapy for PTC. |
| first_indexed | 2024-03-12T01:10:09Z |
| format | Article |
| id | doaj.art-c943ad243d53473ab683e9461a37f446 |
| institution | Directory Open Access Journal |
| issn | 2376-0605 |
| language | English |
| last_indexed | 2024-03-12T01:10:09Z |
| publishDate | 2023-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | AACE Clinical Case Reports |
| spelling | doaj.art-c943ad243d53473ab683e9461a37f4462023-09-14T04:54:16ZengElsevierAACE Clinical Case Reports2376-06052023-09-0195162165Reduced Tumor Size of Untreated Papillary Thyroid Carcinoma After Immune Checkpoint Inhibitor–Induced ThyroiditisDennis H. Chen, MD0Heinz-Josef Lenz, MD1Melissa G. Lechner, MD/PhD2Trevor E. Angell, MD3Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CaliforniaDivision of Oncology, Norris Comprehensive Cancer Center and Keck School of Medicine of University of Southern California, Los Angeles, CaliforniaDivision of Endocrinology, Diabetes and Metabolism, David Geffen School of Medicine, University of California, Los Angeles, CaliforniaDivision of Endocrinology and Diabetes, Keck School of Medicine of University of Southern California, Los Angeles, California; Address correspondence to Dr Trevor E. Angell, Division of Endocrinology and Diabetes, Keck School of Medicine of University of Southern California, 2020 Zonal Avenue, IRD 620, Los Angeles, CA 90089.Background/Objective: Immune checkpoint inhibitors (CPIs) activate antitumoral immune responses and are used to treat multiple types of primary and metastatic malignancies. Thyroid dysfunction is a known immune-related adverse event of CPI therapy. There are few data on the effect of CPI and CPI-induced thyroiditis on primary papillary thyroid carcinoma (PTC). We present a patient who developed CPI-induced thyroiditis during treatment for a nonthyroid malignancy and subsequent regression of a coexisting untreated primary PTC. Case Report: A 49-year-old man with metastatic colon adenocarcinoma was found to have a large right thyroid nodule with biopsy confirmation of PTC. He did not have compressive symptoms or evidence of metastatic PTC. Resection was not performed because of colon cancer therapy. Treatment with CPI (ezabenlimab, an anti–programmed cell death protein 1 antibody) was initiated for the treatment of colon cancer. Four months after the initiation of CPI therapy, testing showed thyroid–stimulating hormone and free thyroxine levels of 174.9 (0.3-4.0 mIU/L) and 0.67 (0.93-1.70 ng/dL), respectively, consistent with CPI-induced hypothyroidism. Levothyroxine therapy was initiated. Repeat imaging 3 months later demonstrated a decrease in the tumor size to 4.1 × 4.9 × 4.2 cm (calculated volume change, −8.3% from baseline). At the last imaging, 1 year after the onset of CPI-induced thyroiditis, the PTC continued to decrease in size and measured 2.9 × 3.9 × 3.2 cm (volume change, −60.7% from baseline). Discussion: CPI-induced thyroiditis suggests the development of an immune response against thyroid tissue and may reflect a similar increased immune response against PTC cells leading to tumor regression in this case. Conclusion: Further research to assess the immunologic mechanism underlying this association is warranted to potentially develop improved immunotherapy for PTC.http://www.sciencedirect.com/science/article/pii/S2376060523001153papillary thyroid carcinomaimmune checkpoint inhibitorsimmune-related adverse eventsefficacythyroiditis |
| spellingShingle | Dennis H. Chen, MD Heinz-Josef Lenz, MD Melissa G. Lechner, MD/PhD Trevor E. Angell, MD Reduced Tumor Size of Untreated Papillary Thyroid Carcinoma After Immune Checkpoint Inhibitor–Induced Thyroiditis AACE Clinical Case Reports papillary thyroid carcinoma immune checkpoint inhibitors immune-related adverse events efficacy thyroiditis |
| title | Reduced Tumor Size of Untreated Papillary Thyroid Carcinoma After Immune Checkpoint Inhibitor–Induced Thyroiditis |
| title_full | Reduced Tumor Size of Untreated Papillary Thyroid Carcinoma After Immune Checkpoint Inhibitor–Induced Thyroiditis |
| title_fullStr | Reduced Tumor Size of Untreated Papillary Thyroid Carcinoma After Immune Checkpoint Inhibitor–Induced Thyroiditis |
| title_full_unstemmed | Reduced Tumor Size of Untreated Papillary Thyroid Carcinoma After Immune Checkpoint Inhibitor–Induced Thyroiditis |
| title_short | Reduced Tumor Size of Untreated Papillary Thyroid Carcinoma After Immune Checkpoint Inhibitor–Induced Thyroiditis |
| title_sort | reduced tumor size of untreated papillary thyroid carcinoma after immune checkpoint inhibitor induced thyroiditis |
| topic | papillary thyroid carcinoma immune checkpoint inhibitors immune-related adverse events efficacy thyroiditis |
| url | http://www.sciencedirect.com/science/article/pii/S2376060523001153 |
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