Nivolumab-induced thyroid dysfunction in patients with lung cancer.
Endocrinol Diabetes Nutr (Engl Ed)
; 66(1): 26-34, 2019 Jan.
Article
em En, Es
| MEDLINE
| ID: mdl-29910159
ABSTRACT
BACKGROUND:
Nivolumab is an anti-cancer monoclonal antibody that inhibits PD1 and modulates T-cell response. It has been shown to significantly improve survival in several types of cancer, but clinical trials have also reported an increased risk of developing immune-related adverse events (IRAEs). Endocrine IRAEs may be particularly relevant.OBJECTIVE:
To comprehensively evaluate the clinical presentation of endocrine IRAEs in patients with lung cancer treated with nivolumab. Potential risk factors are analyzed, and strategies for IRAE management are proposed.METHODS:
Forty consecutive patients treated with nivolumab for advanced non-small cell lung cancer (NSCLC) were studied, paying particular attention to development of endocrine IRAEs (thyroid, hypophyseal, adrenal, or pancreatic) and clinical outcome.RESULTS:
Thyroid function changes were found in 9 patients (22.5%), of which six developed hypothyroidism and three had hyperthyroidism after a median of 3.8 and 2.3 cycles of nivolumab respectively. Only one patient had thyroid-related symptoms. Thyroid autoimmunity was negative in all cases. Hyperthyroid patients showed no uptake in iodine scintigraphy, and their hormone values returned to normal in less than six months. Nivolumab was discontinued for toxicity in one patient. One patient with hyperthyroidism also developed autoimmune diabetes, and one patient with hypothyroidism also had hypogonadism. After a median follow-up of 7.6 months, 25 patients (62.5%) showed response to nivolumab. Univariate and multivariate analyses showed no differences between patients who developed thyroid changes and those who did not.CONCLUSIONS:
Thyroid changes after treatment with nivolumab are common and warrant active laboratory monitoring. The underlying mechanisms and their relevance deserve further research.Palavras-chave
Cáncer de pulmón; Cáncer de pulmón de células no pequeñas; Endocrine toxicity; Hipertiroidismo; Hipotiroidismo; Hyperthyroidism; Hypothyroidism; Immune checkpoint inhibitors; Inhibidores de los checkpoint inmunes; Lung cancer; Nivolumab; Non-small cell lung cancer; PD1; Thyroid toxicity; Thyroiditis; Tiroiditis; Toxicidad endocrina; Toxicidad tiroidea
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Doenças da Glândula Tireoide
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Carcinoma Pulmonar de Células não Pequenas
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Antineoplásicos Imunológicos
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Nivolumabe
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Neoplasias Pulmonares
Tipo de estudo:
Etiology_studies
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Observational_studies
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Risk_factors_studies
Limite:
Adult
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Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
/
Es
Revista:
Endocrinol Diabetes Nutr (Engl Ed)
Ano de publicação:
2019
Tipo de documento:
Article