Clinical Presentation of Immune-Related Endocrine Adverse Events during Immune Checkpoint Inhibitor Treatment
The exact clinical course and factors associated with persistent endocrine immune-related adverse events (irAEs) are not well-established. Elucidation of these information will aid irAEs screening and follow-up planning for patients on immunotherapy. We analysed the clinical course of endocrine irAE...
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MDPI AG
2022-05-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/14/11/2687 |
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| author | Jenny Hui Ling Chieng Zaw Win Htet Joseph J. Zhao E Shyong Tai Sen Hee Tay Yiqing Huang Alvin Wong Samantha Peiling Yang |
| author_facet | Jenny Hui Ling Chieng Zaw Win Htet Joseph J. Zhao E Shyong Tai Sen Hee Tay Yiqing Huang Alvin Wong Samantha Peiling Yang |
| author_sort | Jenny Hui Ling Chieng |
| collection | DOAJ |
| description | The exact clinical course and factors associated with persistent endocrine immune-related adverse events (irAEs) are not well-established. Elucidation of these information will aid irAEs screening and follow-up planning for patients on immunotherapy. We analysed the clinical course of endocrine irAEs including thyroid and pituitary dysfunction and insulin-dependent diabetes mellitus (IDDM), identified factors associated with persistent thyroid dysfunction, and determined the association between endocrine irAEs and survival parameters. This retrospective observational study enrolled patients with metastatic cancer who underwent anti-PD-1, anti-PD-L1, and/or anti-CTLA-4 treatment and developed endocrine irAE at the National University Cancer Institute, Singapore, between June 2015 and December 2020. Sixty-six patients with endocrine irAE were evaluated, with a median follow-up time of 15.7 months. The median time to onset of thyroid dysfunction, pituitary dysfunction, and IDDM was 1.8 months (range: 0.3–15.8 months), 6.8 months (range: 1.5–27.3 months), and 7.8 months (range: 1.4–9.1 months), respectively. Positive thyroperoxidase antibodies (TPOAb) and/ or thyroglobulin antibodies (TgAb) status at the time of thyroid dysfunction was associated with persistent thyroid dysfunction (OR 11.6, 95% CI 1.3–570.8, <i>p</i> = 0.02; OR 8.8, 95% CI 1.3–106.9, <i>p</i> = 0.01, respectively). All patients with pituitary irAE had central hypocortisolism. All patients with IDDM had grade 4 irAE. Patients with endocrine irAE had longer median survival times. Endocrine irAEs were associated with non-progressive disease. The screening and follow-up approach for endocrine irAEs should be tailored according to each endocrinopathy’s clinical course. Early screening is imperative given its wide median time to onset. |
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| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T01:27:15Z |
| publishDate | 2022-05-01 |
| publisher | MDPI AG |
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| series | Cancers |
| spelling | doaj.art-dfae70c91da6422782a11fa17a5abbe52023-11-23T13:49:27ZengMDPI AGCancers2072-66942022-05-011411268710.3390/cancers14112687Clinical Presentation of Immune-Related Endocrine Adverse Events during Immune Checkpoint Inhibitor TreatmentJenny Hui Ling Chieng0Zaw Win Htet1Joseph J. Zhao2E Shyong Tai3Sen Hee Tay4Yiqing Huang5Alvin Wong6Samantha Peiling Yang7Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, SingaporeDivision of Endocrinology, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, SingaporeYong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, SingaporeYong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, SingaporeDivision of Rheumatology, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, SingaporeDepartment of Haematology-Oncology, National University Cancer Institute, 5 Lower Kent Ridge Road, Singapore 119074, SingaporeDepartment of Haematology-Oncology, National University Cancer Institute, 5 Lower Kent Ridge Road, Singapore 119074, SingaporeYong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, SingaporeThe exact clinical course and factors associated with persistent endocrine immune-related adverse events (irAEs) are not well-established. Elucidation of these information will aid irAEs screening and follow-up planning for patients on immunotherapy. We analysed the clinical course of endocrine irAEs including thyroid and pituitary dysfunction and insulin-dependent diabetes mellitus (IDDM), identified factors associated with persistent thyroid dysfunction, and determined the association between endocrine irAEs and survival parameters. This retrospective observational study enrolled patients with metastatic cancer who underwent anti-PD-1, anti-PD-L1, and/or anti-CTLA-4 treatment and developed endocrine irAE at the National University Cancer Institute, Singapore, between June 2015 and December 2020. Sixty-six patients with endocrine irAE were evaluated, with a median follow-up time of 15.7 months. The median time to onset of thyroid dysfunction, pituitary dysfunction, and IDDM was 1.8 months (range: 0.3–15.8 months), 6.8 months (range: 1.5–27.3 months), and 7.8 months (range: 1.4–9.1 months), respectively. Positive thyroperoxidase antibodies (TPOAb) and/ or thyroglobulin antibodies (TgAb) status at the time of thyroid dysfunction was associated with persistent thyroid dysfunction (OR 11.6, 95% CI 1.3–570.8, <i>p</i> = 0.02; OR 8.8, 95% CI 1.3–106.9, <i>p</i> = 0.01, respectively). All patients with pituitary irAE had central hypocortisolism. All patients with IDDM had grade 4 irAE. Patients with endocrine irAE had longer median survival times. Endocrine irAEs were associated with non-progressive disease. The screening and follow-up approach for endocrine irAEs should be tailored according to each endocrinopathy’s clinical course. Early screening is imperative given its wide median time to onset.https://www.mdpi.com/2072-6694/14/11/2687immune-related endocrine adverse eventsimmune checkpoint inhibitor treatmentthyroid dysfunctionpituitary dysfunctioninsulin-dependent diabetes mellitussurvival analysis |
| spellingShingle | Jenny Hui Ling Chieng Zaw Win Htet Joseph J. Zhao E Shyong Tai Sen Hee Tay Yiqing Huang Alvin Wong Samantha Peiling Yang Clinical Presentation of Immune-Related Endocrine Adverse Events during Immune Checkpoint Inhibitor Treatment Cancers immune-related endocrine adverse events immune checkpoint inhibitor treatment thyroid dysfunction pituitary dysfunction insulin-dependent diabetes mellitus survival analysis |
| title | Clinical Presentation of Immune-Related Endocrine Adverse Events during Immune Checkpoint Inhibitor Treatment |
| title_full | Clinical Presentation of Immune-Related Endocrine Adverse Events during Immune Checkpoint Inhibitor Treatment |
| title_fullStr | Clinical Presentation of Immune-Related Endocrine Adverse Events during Immune Checkpoint Inhibitor Treatment |
| title_full_unstemmed | Clinical Presentation of Immune-Related Endocrine Adverse Events during Immune Checkpoint Inhibitor Treatment |
| title_short | Clinical Presentation of Immune-Related Endocrine Adverse Events during Immune Checkpoint Inhibitor Treatment |
| title_sort | clinical presentation of immune related endocrine adverse events during immune checkpoint inhibitor treatment |
| topic | immune-related endocrine adverse events immune checkpoint inhibitor treatment thyroid dysfunction pituitary dysfunction insulin-dependent diabetes mellitus survival analysis |
| url | https://www.mdpi.com/2072-6694/14/11/2687 |
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