Higher baseline TSH levels predict early hypothyroidism during cancer immunotherapy.
Adult
Aged
Aged, 80 and over
Antineoplastic Agents, Immunological
/ adverse effects
Female
Humans
Hypothyroidism
/ blood
Immune Checkpoint Inhibitors
/ adverse effects
Immunotherapy
/ adverse effects
Kaplan-Meier Estimate
Male
Middle Aged
Neoplasms
/ complications
Progression-Free Survival
Retrospective Studies
Risk Factors
Survival Analysis
Thyroid Function Tests
Thyrotoxicosis
/ epidemiology
Thyrotropin
/ blood
Treatment Outcome
Anti-thyroid antibodies
Hypothyroidism
Immunotherapy
Thyroid immuno-related adverse events
Journal
Journal of endocrinological investigation
ISSN: 1720-8386
Titre abrégé: J Endocrinol Invest
Pays: Italy
ID NLM: 7806594
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
received:
03
12
2020
accepted:
10
01
2021
pubmed:
13
2
2021
medline:
1
1
2022
entrez:
12
2
2021
Statut:
ppublish
Résumé
Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that enhance the immune response against cancer cells. ICIs are generally well tolerated, although endocrine immune-related adverse events (irAEs) are common. We investigated the risk factors for thyroid irAEs in patients treated with ICIs. Moreover, we evaluated the clinical outcome of subjects who became hypothyroid compared to euthyroid patients. We retrospectively analyzed a series of 195 consecutively subjects treated with ICIs for metastatic tumors at the University of Naples "Federico II" between January 2014 and March 2020. Only subjects tested for thyroid function before and during the treatment with ICIs were included. In the 96 patients treated with ICIs who were included [66 males, median age: 62 years (27-87)], thyroid irAEs occurred in 36 (37.5%), 16 (16.7%) a transient thyrotoxicosis, and 20 (20.8%) an hypothyroidism (in nine subjects hypothyroidism was preceded by a transient thyrotoxicosis). Only baseline TSH levels above 1.67 mIU/L and positive anti-thyroid antibodies (Ab-T) were associated with a higher risk of hypothyroidism. Patients with hypothyroidism during ICI treatment showed an improved 2-year PFS (HR = 0.82 CI 0.47-1.43; p = 0.0132) and OS (HR = 0.38 CI 95% 0.17-0.80; p = 0.011) compared to euthyroid patients. Baseline TSH levels above 1.67 mIU/L and presence of Ab-T are risk factors for the development of thyroid irAEs. Patients affected by thyroid irAEs showed a longer survival than patients who remained euthyroid.
Sections du résumé
BACKGROUND AND PURPOSE
OBJECTIVE
Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that enhance the immune response against cancer cells. ICIs are generally well tolerated, although endocrine immune-related adverse events (irAEs) are common. We investigated the risk factors for thyroid irAEs in patients treated with ICIs. Moreover, we evaluated the clinical outcome of subjects who became hypothyroid compared to euthyroid patients.
PATIENTS AND METHODS
METHODS
We retrospectively analyzed a series of 195 consecutively subjects treated with ICIs for metastatic tumors at the University of Naples "Federico II" between January 2014 and March 2020. Only subjects tested for thyroid function before and during the treatment with ICIs were included.
RESULTS
RESULTS
In the 96 patients treated with ICIs who were included [66 males, median age: 62 years (27-87)], thyroid irAEs occurred in 36 (37.5%), 16 (16.7%) a transient thyrotoxicosis, and 20 (20.8%) an hypothyroidism (in nine subjects hypothyroidism was preceded by a transient thyrotoxicosis). Only baseline TSH levels above 1.67 mIU/L and positive anti-thyroid antibodies (Ab-T) were associated with a higher risk of hypothyroidism. Patients with hypothyroidism during ICI treatment showed an improved 2-year PFS (HR = 0.82 CI 0.47-1.43; p = 0.0132) and OS (HR = 0.38 CI 95% 0.17-0.80; p = 0.011) compared to euthyroid patients.
CONCLUSIONS
CONCLUSIONS
Baseline TSH levels above 1.67 mIU/L and presence of Ab-T are risk factors for the development of thyroid irAEs. Patients affected by thyroid irAEs showed a longer survival than patients who remained euthyroid.
Identifiants
pubmed: 33576954
doi: 10.1007/s40618-021-01508-5
pii: 10.1007/s40618-021-01508-5
pmc: PMC8357750
doi:
Substances chimiques
Antineoplastic Agents, Immunological
0
Immune Checkpoint Inhibitors
0
Thyrotropin
9002-71-5
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1927-1933Informations de copyright
© 2021. The Author(s).
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