Alqahtani Ali, Alghamdi Lamia, Alghassab Abdulmohsen, Almalki Mussa
Obesity, Endocrine, and Metabolism Center, King Fahad Medical City, Riyadh, SAU.
Cureus. 2023 Aug 28;15(8):e44296. doi: 10.7759/cureus.44296. eCollection 2023 Aug.
Immune checkpoint inhibitors (ICIs) are approved to treat several types of cancer, but they may cause an exaggerated immune response. This can lead to immune-related adverse events such as endocrinopathies, which mostly affect the thyroid and pituitary gland.
A retrospective analysis was conducted on 125 cancer patients receiving ICIs (pembrolizumab, nivolumab, and ipilimumab) between July 2018 and July 2022. The study reviewed hormone test results and the clinical perspectives of patients to identify and characterize endocrine adverse events associated with ICI therapy in cancer patients.
Among the 125 patients who were examined, a total of 26 patients (20.8%) encountered endocrine-related adverse effects. A total of 25 patients had thyroid dysfunction. Hypophysitis was detected in a limited cohort of two patients, along with primary hypothyroidism. A case of newly diagnosed type 1 diabetes mellitus was seen in a single patient. None of the patients had primary adrenal insufficiency or parathyroid dysfunction. The administration of pembrolizumab was shown to be associated with the occurrence of thyroid dysfunction in 18 cases, as well as two cases of hypophysitis. In contrast, nivolumab was responsible for inducing thyroid dysfunction in four cases. The remaining occurrences were attributable to combination treatment.
The study found an increased risk of thyroid dysfunction among cancer patients receiving ICIs, while pituitary dysfunction was a less frequent adverse effect. It is recommended that an endocrine assessment be conducted before therapy initiation and periodically afterward.
免疫检查点抑制剂（ICIs）已被批准用于治疗多种类型的癌症，但它们可能会引发过度的免疫反应。这可能导致免疫相关的不良事件，如内分泌病，其中大多数影响甲状腺和垂体。
对2018年7月至2022年7月期间接受ICIs（帕博利珠单抗、纳武利尤单抗和伊匹木单抗）治疗的125例癌症患者进行回顾性分析。该研究回顾了激素检测结果和患者的临床情况，以识别和描述癌症患者中与ICI治疗相关的内分泌不良事件。
在接受检查的125例患者中，共有26例（20.8%）出现内分泌相关不良反应。共有25例患者出现甲状腺功能障碍。在有限的2例患者队列中检测到垂体炎，同时伴有原发性甲状腺功能减退。在1例患者中发现1例新诊断的1型糖尿病。所有患者均无原发性肾上腺功能不全或甲状旁腺功能障碍。帕博利珠单抗的使用与18例甲状腺功能障碍以及2例垂体炎的发生相关。相比之下，纳武利尤单抗导致4例甲状腺功能障碍。其余病例归因于联合治疗。
该研究发现接受ICIs治疗的癌症患者甲状腺功能障碍风险增加，而垂体功能障碍是较不常见的不良反应。建议在治疗开始前及之后定期进行内分泌评估。
