Immune checkpoint inhibitor therapy for ACTH-secreting pituitary carcinoma: a new emerging treatment?
ACTH-Secreting Pituitary Adenoma
/ drug therapy
Adenoma
/ drug therapy
Adult
Antineoplastic Agents, Immunological
/ therapeutic use
Antineoplastic Combined Chemotherapy Protocols
/ therapeutic use
Carcinoma
/ drug therapy
Cell Cycle Checkpoints
/ immunology
Humans
Ipilimumab
/ therapeutic use
Male
Nivolumab
/ therapeutic use
Journal
European journal of endocrinology
ISSN: 1479-683X
Titre abrégé: Eur J Endocrinol
Pays: England
ID NLM: 9423848
Informations de publication
Date de publication:
Jan 2021
Jan 2021
Historique:
received:
02
03
2020
accepted:
05
10
2020
pubmed:
29
10
2020
medline:
1
12
2020
entrez:
28
10
2020
Statut:
ppublish
Résumé
Pituitary carcinomas are rare but aggressive and require maximally coordinated multimodal therapies. For refractory tumors, unresponsive to temozolomide (TMZ), therapeutic options are limited. Immune checkpoint inhibitors (ICI) may be considered for treatment as illustrated in the present case report. We report a patient with ACTH-secreting pituitary carcinoma, progressive after multiple lines of therapy including chemotherapy with TMZ, who demonstrated disease stabilization by a combination of ipilimumab (anti-CTLA-4) and nivolumab (anti-PD-1) ICI therapy. Management of pituitary carcinoma beyond TMZ remains ill-defined and relies on case reports. TMZ creates, due to hypermutation, more immunogenic tumors and subsequently potential candidates for ICI therapy. This case report adds support to the possible role of ICI in the treatment of pituitary carcinoma. ICI therapy could be a promising treatment option for pituitary carcinoma, considering the mechanisms of TMZ-induced hypermutation with increased immunogenicity, pituitary expression of CTLA-4 and PD-L1, and the frequent occurrence of hypophysitis as a side effect of ICI therapy.
Sections du résumé
BACKGROUND
BACKGROUND
Pituitary carcinomas are rare but aggressive and require maximally coordinated multimodal therapies. For refractory tumors, unresponsive to temozolomide (TMZ), therapeutic options are limited. Immune checkpoint inhibitors (ICI) may be considered for treatment as illustrated in the present case report.
CASE
METHODS
We report a patient with ACTH-secreting pituitary carcinoma, progressive after multiple lines of therapy including chemotherapy with TMZ, who demonstrated disease stabilization by a combination of ipilimumab (anti-CTLA-4) and nivolumab (anti-PD-1) ICI therapy.
DISCUSSION
CONCLUSIONS
Management of pituitary carcinoma beyond TMZ remains ill-defined and relies on case reports. TMZ creates, due to hypermutation, more immunogenic tumors and subsequently potential candidates for ICI therapy. This case report adds support to the possible role of ICI in the treatment of pituitary carcinoma.
CONCLUSION
CONCLUSIONS
ICI therapy could be a promising treatment option for pituitary carcinoma, considering the mechanisms of TMZ-induced hypermutation with increased immunogenicity, pituitary expression of CTLA-4 and PD-L1, and the frequent occurrence of hypophysitis as a side effect of ICI therapy.
Identifiants
pubmed: 33112279
doi: 10.1530/EJE-20-0151
pii: EJE-20-0151
pmc: PMC7707801
doi:
pii:
Substances chimiques
Antineoplastic Agents, Immunological
0
Ipilimumab
0
Nivolumab
31YO63LBSN
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
K1-K5Références
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