Reactions 1680, p191 - 2 Dec 2017 Hyperthyroidism, hypothyroidism and hypophysitis : 9 case reports In a retrospective study, 9 patients (4 men and 5 women; aged 50–76-years) were described, who developed hyperthyroidism, hypothyroidism or hypophysitis during treatment with nivolumab alone or nivolumab and ipilimumab [not all dosages stated; routes not stated]. The patients, who had metastatic renal cell carcinoma (1 patient), multiple myeloma (2 patients), metastatic lung cancer (2 patients), metastatic bladder cancer (1 patient), metastatic oesophageal cancer (1 patient) or metastatic melanoma (2 patients), were started on monotherapy with nivolumab 3 mg/kg (6 patients) or nivolumab 1 mg/kg and ipilimumab (2 patients) or nivolumab 1mg/kg for three months followed by 3 mg/kg and ipilimumab (1 patient). Time to first detection of abnormal thyroid blood test after initiation of treatment was 21–249 days. The Anti-TPO antibody was positive in 3 patients (patient 2,5 and 9). The Anti-TG antibody was positive in 5 patients (patient 2,3,4,5 and 7). The TSH levels were less than 0.4 µIU/mL to 56 µIU/mL (ref: more than 0.4 to less than 4.2 µIU/mL). Three patients (patient 1,2 and 7) initially developed hyperthyroidism and then hypothyroidism. Patient 6 and 8 developed only hyperthyroidism and patient 6 was lost to follow-up. The patient 8 also developed hypophysitis, while his hyperthyroidism recovered spontaneously. The remaining four patients developed only hypothyroidism (Patient 3,4,5 and 9) [not all outcomes stated]. Author comment: "The most common endocrine complication observed with [ipilimumab] is hypophysitis, while the most common endocrinopathy reported with PD-1 inhibitors is thyroid disease" "Combination therapy with a PD-1 inhibitor and [ipilimumab] may increase the risk of thyroid disease compared with [nivolumab] alone, as has been reported previously in clinical trials" O’Malley G, et al. RAPID EVOLUTION of THYROID DYSFUNCTION in PATIENTS TREATED with NIVOLUMAB. Endocrine Practice 23: 1223-1231, No. 10, Oct 2017. Available from: URL: http://doi.org/10.4158/EP171832.OR - USA 803284675 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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