Thyroid Immune-Related Adverse Events in Patients with Cancer Treated with anti-PD1/anti-CTLA4 Immune Checkpoint Inhibitor Combination: Clinical Course and Outcomes
| Autor: | Vikki Tang, Yu Cho Woo, David T W Lui, Alan Chun Hong Lee, Gerry Gin Wai Kwok, Tan To Cheung, R. Leung, Bryan Cho Wing Li, Karen S.L. Lam, Thomas Yau, Joanne Wing Yan Chiu, Chi Ho Lee, Carol H.Y. Fong |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Endocrinology Diabetes and Metabolism Programmed Cell Death 1 Receptor Thyroid Gland 030209 endocrinology & metabolism Thyroid function tests 03 medical and health sciences 0302 clinical medicine Endocrinology Neoplasms Internal medicine medicine Humans CTLA-4 Antigen 030212 general & internal medicine Adverse effect Immune Checkpoint Inhibitors Retrospective Studies Subclinical infection medicine.diagnostic_test business.industry Thyroid Hazard ratio Cancer General Medicine Odds ratio Middle Aged medicine.disease Thyroid Diseases Anti-thyroid autoantibodies medicine.anatomical_structure Female business |
| Zdroj: | Endocrine Practice. 27:886-893 |
| ISSN: | 1530-891X |
| DOI: | 10.1016/j.eprac.2021.01.017 |
| Popis: | Objective Thyroid immune-related adverse events (irAEs) have been reported to have prognostic significance among patients with cancer treated with anti-programmed cell death-1 (PD1) and anti-programmed death-ligand 1 monotherapies. We evaluated the clinical course and predictors of thyroid irAEs in relation to outcomes of patients with advanced cancer treated with combination anti-PD1/anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA4). Methods We conducted a regional study and identified patients with advanced cancer who received ≥1 cycle of combination anti-PD1/anti-CTLA4 between 2015 and 2019 in Hong Kong. Thyroid function tests (TFTs) were monitored every 3 weeks. Thyroid irAE was defined by ≥2 abnormal TFTs after initiation of combination anti-PD1/anti-CTLA4 in the absence of other causes. Results One hundred and three patients were included (median age: 59 years; 71.8% men). About 45% had prior anti-PD1 exposure. Upon median follow-up of 6.8 months, 17 patients (16.5%) developed thyroid irAEs, where 6 initially presented with thyrotoxicosis (overt, n = 4; subclinical, n = 2) and 11 with hypothyroidism (overt, n = 2; subclinical, n = 9). Eventually, 10 patients (58.8%) required continuous thyroxine replacement. Systemic steroid was not required in all cases. Prior anti-PD1 exposure (odds ratio, 3.67; 95% CI, 1.19–11.4; P = .024) independently predicted thyroid irAEs. Multivariable Cox regression analysis revealed that occurrence of thyroid irAEs was independently associated with better overall survival (adjusted hazard ratio, 0.34; 95% CI, 0.17–0.71; P = .004). Conclusion Thyroid irAEs are common in routine clinical practice among patients with advanced cancer treated with anti-PD1/anti-CTLA4 combination and might have potential prognostic significance. Regular TFT monitoring is advised for timely treatment of thyroid irAEs to prevent potential morbidities. |
| Databáze: | OpenAIRE |
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