ECE2023 Eposter Presentations Endocrine-related Cancer (80 abstracts)
Endocrinopathies in oncological patients treated with immunotherapy: A real world data study
Anna Angelousi 1 , Athina Karampela 1 , Spyridon Kazanas 2 , Petros Papalexis 1 , Alexandros Lafioniatis 1 , Vasiliki Siampanopoulou 1 , Chrysoula Mytareli 1 , Maria Theochari 3 , Dimitra Stephanou 3 , Dimitrios Ziogas 3 & Helen Gogas 3
1Laiko General Hospital, First Department of Internal Medicine, Unit of Endocrinology, Athina, Greece; 2Laiko General Hospital, First Department of Internal Medicine, Greece; 3Laiko General Hospital, First Department of Internal Medicine, Unit of Medical Oncology, Athina, Greece
Background: Immune checkpoint inhibitors (ICIs) (anti-CTLA-4, PD-1 inhibitors, PD-L1 inhibitors) are considered a widely used therapeutic choice for several cancer types. However ICI therapy is frequently complicated by adverse events; endocrine toxicities are the most common ones.
Methods: To assess in a retrospective observational study in a tertiary hospital the incidence and the characteristics of the immunotherapy-related endocrine adverse events (irEAEs) in oncological patients treated with ICIs. All patients had baseline hormonal functional tests (before the initiation of ICIs) and during the follow-up (mean: 20 months).
Results: A total of 117 irEAEs cases were registrated out of 1077 (10.86%) oncological patients treated with ICIs (46% females). The mean time of diagnosis of irEAEs was 7.7 months after the onset of ICIs treatment with recovery in 9.4% of patients during the follow-up. The overall incidence of hypophysitis and thyroid dysfunctions was 6.9% and 4% respectively in patients treated with ICIs. Among the 117 irEAEs cases, 63.2% (74 cases) presented with hypophysitis followed by 24.8% with primary hypothyroidism (29 cases) and 10.3%with thyreotoxicosis (12 cases). Furthermore, one case developed diabetes insipidus, one case primary adrenal insufficiency and two cases primary hypogonadism. Hypophysytis was diagnosed in 75% of patients treated with anti-CTLA-4 inhibitors vs. 61.5% of patients treated with PD-1/PDL-1 and 72.4% with combination treatment. Thyroid disorders were noted in 36% of patients treated with PD-1/PDL-1 vs. 25% of patients with anti-CTLA-4 inhibitors and 25.5% with combination treatment. Hypophysitis was reversible in 9.5% of patients whereas primary thyroid disorders in 25.8% of cases with irEAEs. Interestingly reversibility was significantly associated with the time of diagnosis of irEAEs. Thyroid autoantibodies were found positive in 44% of cases with primary hypothyroidism and in 30% of cases with no thyroid dysfunction. No MRI was performed systematically among patients with hypophysitis. However in 20 out of 34 (58%) of patients with hypophysitis, MRI presented pathological findings.
Conclusions: irEAEs are relatively frequent in patients treated with ICIs, thus physicians should be aware of the clinical signs/symptoms in order to proceed to an early diagnosis and treatment. The complexity of the pathophysiological mechanisms of action of ICIs requires a multidisciplinary approach of these patients.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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