Endocrinology, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, AOU Careggi, Viale Pieraccini, 6, 50139, Florence, Italy.
Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, AOU Careggi, 50139, Florence, Italy.
J Endocrinol Invest. 2020 Mar;43(3):337-345. doi: 10.1007/s40618-019-01112-8. Epub 2019 Sep 21.
The immune checkpoint inhibitors (ICPIs) agents anti-T lymphocytes-associated antigen 4 (CTLA-4) and anti-programmed cell death protein-1 (PD-1) and its ligands (PD-L1/PD-L2) have opened a new scenario in the treatment of cancer. These agents can induce immuno-related adverse events (irAEs), which may affect the endocrine system.
The aim of this study was to analyze the occurrence and the course of endocrine irAEs in cancer patients treated with anti-PD-1 immunotherapy.
This was a retrospective, multicentre study, involving cancer patients treated with the PD-1 inhibitors nivolumab or pembrolizumab at reference Oncology Centres. One hundred and seventy-nine consecutive patients with different types of cancer (mostly non-small cell lung cancer, melanoma, kidney cancer) were included in the study. Patients had received nivolumab (70.9%) or pembrolizumab (29.1%) for 2-33 months. The study evaluated clinical data records until the established date of July 15, 2018. The primary end point was the assessment of endocrine toxicity and possible predictive factors.
Endocrine toxicity occurred in 54 out of 179 patients (30.2%) and was related to thyroid dysfunction, with the exception of one case of diabetes mellitus. Thyroid toxicity occurred mostly within 2 months from the initiation of immunotherapy (83% of cases). A pre-existing thyroid dysfunction was a significant predictor of disease flare.
Thyroid alterations are frequently associated with anti PD-1 treatment in cancer patients. Regular thyroid assessment should be performed, particularly in the first months of treatment and in patients with a pre-existing thyroid disease.
免疫检查点抑制剂（ICPI）抗 T 淋巴细胞相关抗原 4（CTLA-4）和抗程序性细胞死亡蛋白-1（PD-1）及其配体（PD-L1/PD-L2）为癌症治疗开辟了新局面。这些药物可引发免疫相关不良反应（irAE），可能影响内分泌系统。
本研究旨在分析接受抗 PD-1 免疫治疗的癌症患者内分泌 irAE 的发生和过程。
这是一项回顾性多中心研究，涉及在参考肿瘤中心接受 PD-1 抑制剂纳武单抗或帕博利珠单抗治疗的癌症患者。共纳入 179 例不同类型癌症（主要是非小细胞肺癌、黑色素瘤、肾癌）患者。患者接受纳武单抗（70.9%）或帕博利珠单抗（29.1%）治疗 2-33 个月。研究评估了截至 2018 年 7 月 15 日建立的日期之前的临床数据记录。主要终点是评估内分泌毒性和可能的预测因素。
179 例患者中有 54 例（30.2%）发生内分泌毒性，与甲状腺功能障碍有关，除外 1 例糖尿病。甲状腺毒性大多发生在免疫治疗开始后 2 个月内（83%的病例）。存在甲状腺功能障碍是疾病加重的显著预测因素。
甲状腺改变与癌症患者接受抗 PD-1 治疗经常相关。应定期进行甲状腺评估，尤其是在治疗的最初几个月和存在甲状腺疾病的患者中。
