Endocrine Abstracts

Lung cancer (LC) is a serious health problem worldwide. Survival outcomes have improved over time, due to the widespread adoption of therapeutic agents, including immune checkpoint inhibitors (ICIs). Endocrine immune-related adverse events (irAEs) are common in LC patients treated with ICIs. A retrospective study of LC patients was performed in a tertiary center for cases seen between January 2014 and October 2023. In total, 983 LC patients were included in the study, with a median age of 67 years. 670 patients (68.1%) received treatment with a PD-1 inhibitor, 221 patients (22.5%) with a PD-L1 inhibitor and 92 patients (9.4%) a combined therapy with a PD-1 and a CTLA-4 inhibitor. Endocrine irAEs presented at a median time of 4.1 months and included hypothyroidism (15.6%), hyperthyroidism (4.3%), adrenal insufficiency, (0.4%), hypophysitis, (0.4%), and diabetes mellitus, (0.2%). The median time to onset of thyroid disease showed a statistically significant difference (P=0.004), between hypothyroidism (4.87 months, 95% CI: 4.07 - 5.63 months), and hyperthyroidism (2.62 months, 95% CI: 2.10-3.77 months). The incidence of endocrine irAEs was similar between different classes of ICIs. Most (97.6%) endocrine irAEs were mild (grade 1-2) and did not require treatment interruption. In multivariate analysis, the presence of endocrine irAEs was associated with the presence of endocrine comorbidities at diagnosis, the absence of liver metastases, as well as the development of dermatologic irAEs or other irAEs. Median overall survival (OS) was higher in LC patients who experienced an endocrine irAE (31.6 months) compared to those who did not (10.8 months). The survival difference remained statistically significant in the 3-month (HR: 0.42) and 6-month landmark analysis (HR: 0.51). The OS advantage in patients with endocrine irAEs was observed in both NSCLC (HR: 0.36) and SCLC patients (HR: 0.27). Median progression-free survival was also higher (10.7 vs 3.8 months). Additional research is needed to validate the role of endocrine irAEs as an independent predictor of survival outcomes in LC patients.