Updates in Endocrine Immune-Related Adverse Events in Oncology Immunotherapy

Coniac, Simona; Stoian, Marilena

doi:10.4183/aeb.2021.286

Cited by 7 publications

(7 citation statements)

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“…We had very few patients on Abemaciclib in combination with endocrine therapy (n = 15) and obtained a mean PFS of 11.7 months. We consider that the uneven distribution of the number of patients on each of the three arms-Palbociclib, Ribociclib and Abemaciclib-led to an uneven distribution of PFS, and the much smaller number of patients in this study group compared to the number of patients in the real-world data led to a lower PFS [37][38][39][40][41][42].…”

Section: Discussionmentioning

confidence: 99%

Real-World Outcomes of CDK4/6 Inhibitors Treatment in Metastatic Breast Cancer in Romania

Miron,

Anghel,

Barnonschi

et al. 2023

Diagnostics

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The introduction in clinical practice of selective cyclin-dependent kinase (CDK) 4/6 inhibitors improves the outcome of patients with hormone receptor (HR)-positive human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer (mBC). In Romania, the three available CDK 4/6 inhibitors (Palbociclib, Ribociclib and Ademaciclib) have been approved by the National Agency for Medicines (ANM) in 2019, 2020 and 2021. We conducted a retrospective study from 2019 to 2022 on 107 patients with metastatic breast cancer HR+ that have been treated with CDK 4/6 inhibitors in addition to hormone therapy in the Oncology Department of Colțea Clinical Hospital in Bucharest. The purpose of this study is to calculate the median progression-free survival (PFS) and to compare it with the median PFS from other randomized clinical trials. A key difference from other studies is that our study evaluated both patients with non-visceral mBC and patients with visceral mBC, as these two groups often have different outcomes. A total of 79.4% were postmenopausal patients and 20.6% were premenopausal; 42,1% had different stages at the beginning of disease and 57.9% presented newly metastatic disease. Median PFS was 17 months, unlike randomized clinical trials which reported a median PFS of 25.3 months. The combination of CDK 4/6 inhibitors with endocrine therapy is the golden standard treatment in HR-positive, HER2-negative metastatic breast cancer, bringing a prolongation of survival for these patients. Our results show no major differences compared to randomized clinical trials, despite the smaller patient group. In order to have a picture of the efficacy of the treatment as close as possible to the real-world data, we believe that it would be very useful to have a collaboration between several oncology departments in different institutions to carry out a multi-center study on large groups of patients.

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Section: Discussionmentioning

confidence: 99%

Real-World Outcomes of CDK4/6 Inhibitors Treatment in Metastatic Breast Cancer in Romania

Miron,

Anghel,

Barnonschi

et al. 2023

Diagnostics

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“…In conclusion, immunotherapy has provided a new direction for tumor therapy (5). Thousands of patients with advanced cancer have benefited from ICIs (7). However, immunotherapy incurs multiple side effects (particularly endocrine toxicities), which lower immunological effectiveness and even endanger patients' lives (10).…”

Section: Discussionmentioning

confidence: 99%

“…However, immune checkpoint inhibitor (ICI) therapy frequently comes with immune-related adverse events (irAEs) (6). These effects mainly depend on the diverse tumor and ICI types, distinct from those observed in traditional chemotherapy (7). Some of the irAEs are organ specific events, mainly involving the thyroid, lung, colon, liver and pituitary gland (8).…”

Section: Introductionmentioning

confidence: 99%

Anti‑PD‑1 immune checkpoint inhibitor inducing endocrine toxicity in a patient with advanced lung cancer: A case report and literature review

Bao

Jiang

2022

Exp Ther Med

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The anti-programmed cell death protein 1 (anti-PD-1) antibody is a breakthrough immune checkpoint inhibitor that modulates T-cell function. However, it may result in multiple immune-related adverse events (irAEs), such as endocrine toxicity. The present case report describes a 59-year-old female patient with advanced non-small cell lung cancer with a tumor proportion score of 50% for programmed death ligand 1. The patient developed dry skin, dizziness and fatigue after receiving the third infusion of the anti-PD-1 antibody pembrolizumab. Based on several clinical indicators, including low serum free T3 and free T4 titers, an elevated thyroid-stimulating hormone level and a high titer of thyroid peroxidase autoantibody, the patient was diagnosed with immune-induced autoimmune thyroiditis. The patient received continuous thyroxine replacement therapy until her thyroid function returned to normal. After the fifth infusion of pembrolizumab, the patient exhibited hyperglycemia, high serum ketone levels and low arterial blood pH, thus meeting the criteria for immune-induced autoimmune diabetes and diabetic ketoacidosis. As a result, the immunotherapy was discontinued and the patient was diagnosed with insulin-dependent diabetes mellitus. Following anti-PD-1 medication, the patient experienced autoimmune thyroid damage and autoimmune diabetes. Therefore, clinicians should regularly monitor patients undergoing immunotherapy and pay close attention to the characteristics irAEs. Patients with underlying thyroiditis should be carefully monitored due to this being a risk factor, and for patients with thyroiditis care should be taken when deciding on whether they should be treated with immunotherapy. The article also discusses the features and general mechanisms of immune-related endocrine toxicity.

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“…The most common immune-related endocrinopathies are thyroid gland disorders, usually hypothyroidism, often preceded by transient thyroiditis-induced thyrotoxicosis [ 107 ]. Importantly, endocrinopathies usually require lifelong hormonal replacement, and also require adequate diagnosis, since most of symptoms are non-specific and similar to cancer progression or chemotherapy toxicities [ 108 ]. Here, we review some of the more uncommon immune-related endocrinopathies.…”

Section: Methodsmentioning

confidence: 99%

Immune-Related Uncommon Adverse Events in Patients with Cancer Treated with Immunotherapy

et al. 2022

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Immunotherapy has dramatically changed the therapeutic landscape of oncology, and has become standard of care in multiple cancer types in front or late lines of therapy, with some longstanding responses and outstanding results. Notwithstanding, its use has brought a totally unique spectrum of adverse events, characterized by a myriad of diverse manifestations affecting nearly every organ and system of the body, including the endocrine, nervous, cardiac, respiratory and gastrointestinal systems. Uncommon adverse events, defined as those occurring in less than 1% of patients, comprise an even more heterogeneous group of diseases that are being seen more recurrently as the use of immune check-point inhibitors increases and indications spread in different tumor types and stages. Here, we comprehensively review some uncommon, but exceedingly important, immune-related adverse events, with special emphasis in the clinical approach and diagnostic workup, aiming to reunite the evidence published previously, allowing an increase in awareness and knowledge from all specialists implicated in the diagnosis, treatment, and care of cancer patients treated with immunotherapy.

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Updates in Endocrine Immune-Related Adverse Events in Oncology Immunotherapy

Cited by 7 publications

References 0 publications

Real-World Outcomes of CDK4/6 Inhibitors Treatment in Metastatic Breast Cancer in Romania

Real-World Outcomes of CDK4/6 Inhibitors Treatment in Metastatic Breast Cancer in Romania

Anti‑PD‑1 immune checkpoint inhibitor inducing endocrine toxicity in a patient with advanced lung cancer: A case report and literature review

Immune-Related Uncommon Adverse Events in Patients with Cancer Treated with Immunotherapy

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