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Incidence of Thyroid-Related Adverse Events in Melanoma Patients Treated With Pembrolizumab.

ABSTRACT: Immune checkpoint blockade is associated with endocrine-related adverse events. Thyroid dysfunction during pembrolizumab therapy, an anti-programmed cell death 1 (PD-1) receptor monoclonal antibody, remains to be fully characterized.To assess the incidence and characteristics of pembrolizumab-associated thyroid dysfunction.Thyroid function was monitored prospectively in melanoma patients who initiated pembrolizumab within an expanded access program at a referral oncology center. 18Fluorodeoxyglucose uptake on positron emission tomography/computed tomography (18FDG-PET/CT) was reviewed in cases compatible with inflammatory thyroiditis.Ninety-nine patients with advanced melanoma (age, 26.3-93.6 years; 63.6% females) who received at least one administration of pembrolizumab.Patient characteristics, thyroid function (TSH, free T4), thyroid autoantibodies, and 18FDG-PET/CT.Eighteen adverse events of thyroid dysfunction were observed in 17 patients. Thyrotoxicosis occurred in 12 patients, of which nine evolved to hypothyroidism. Isolated hypothyroidism was present in six patients. Levothyroxine therapy was required in 10 of 15 hypothyroid patients. Thyroid autoantibodies were elevated during thyroid dysfunction in four of 10 cases. Diffuse increased 18FDG uptake by the thyroid gland was observed in all seven thyrotoxic patients who progressed to hypothyroidism.Thyroid dysfunction is common in melanoma patients treated with pembrolizumab. Hypothyroidism and thyrotoxicosis related to inflammatory thyroiditis are the most frequent presentations. Serial measurements of thyroid function tests are indicated during anti-PD-1 monoclonal antibody therapy. Thyrotoxicosis compatible with inflammatory thyroiditis was associated with diffuse increased 18FDG uptake by the thyroid gland. The prospective role of thyroid autoantibodies should be further investigated, together with the histopathological correlates.

SUBMITTER: de Filette J

PROVIDER: S-EPMC5095250 | biostudies-literature | 2016 Nov

REPOSITORIES: biostudies-literature

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Incidence of Thyroid-Related Adverse Events in Melanoma Patients Treated With Pembrolizumab.

de Filette Jeroen J Jansen Yanina Y Schreuer Max M Everaert Hendrik H Velkeniers Brigitte B Neyns Bart B Bravenboer Bert B

The Journal of clinical endocrinology and metabolism 20160829 11

<h4>Context</h4>Immune checkpoint blockade is associated with endocrine-related adverse events. Thyroid dysfunction during pembrolizumab therapy, an anti-programmed cell death 1 (PD-1) receptor monoclonal antibody, remains to be fully characterized.<h4>Objective</h4>To assess the incidence and characteristics of pembrolizumab-associated thyroid dysfunction.<h4>Design and setting</h4>Thyroid function was monitored prospectively in melanoma patients who initiated pembrolizumab within an expanded a ...[more]

PMID: 27571185

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Project description:BackgroundSeveral studies have reported an association between the occurrence of immune-related adverse events (irAEs) and prognosis in patients with melanoma treated with immune checkpoint inhibitors (ICIs), but the results remain controversial. We conducted a systematic review and meta-analysis to investigate the association between irAEs and survival in patients with melanoma treated with ICIs.MethodsWe searched the PubMed, Web of Science, and China National Knowledge Infrastructure databases through May 5, 2022 for clinical studies evaluating the association between irAEs and in melanoma patients treated with ICIs. Combined hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS) were calculated using fixed- or random-effects models based on heterogeneity.ResultsA total of 60 articles were included, with 16,520 patients. In patients with melanoma treated with ICIs, the occurrence of irAEs was significantly associated with better OS (HR, 0.58; 95% confidence interval [CI], 0.51-0.66; P<0.00001) and PFS (HR, 0.61; 95%CI, 0.51-0.72; P<0.00001). Endocrine irAEs (OS, HR, 0.81; 95%CI, 0.72-0.92; P=0.001; PFS: HR, 0.84; 95%CI, 0.73-0.96, P=0.009), skin irAEs (OS, HR, 0.59; 95%CI, 0.41-0.85; P=0.004; PFS: HR, 0.43; 95%CI, 0.36-0.52; P<0.00001), vitiligo (OS, HR, 0.22; 95%CI, 0.15-0.31; P<0.00001; PFS, HR, 0.33; 95%CI, 0.25-0.44; P<0.00001), and grade 1-2 irAEs (OS, HR, 0.67; 95%CI, 0.58-0.78; P<0.00001; PFS, HR, 0.62; 95%CI, 0.51-0.76; P<0.00001) showed similar results. However, thyroid, lung, gastrointestinal, liver, and grade 3-4 irAEs were not significantly associated with OS and PFS. The occurrence of non-thyroid endocrine irAEs was significantly associated with better OS (HR, 0.22; 95%CI, 0.15-0.31; P<0.00001). In patients with melanoma treated with anti-programmed cell death protein 1 (OS, HR, 0.61; 95%CI, 0.51-0.72; P<0.00001; PFS, HR, 0.59; 95%CI, 0.47-0.74; P<0.00001), the association between irAEs and clinical benefit was clearer than in patients treated with anti-cytotoxic T-lymphocyte-associated protein 4 (OS, HR, 0.68; 95%CI, 0.52-0.89; P=0.005; PFS, HR, 0.93; 95%CI, 0.49-1.78; P=0.83).ConclusionAmong patients with melanoma treated with ICIs, those who developed non-thyroid endocrine irAEs and cutaneous irAEs have better prognosis. This suggests that non-thyroid endocrine irAEs and cutaneous irAEs may be a prognostic biomarker for patients with melanoma treated with ICIs.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022338308.

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Incidence of Thyroid-Related Adverse Events in Melanoma Patients Treated With Pembrolizumab.

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Incidence of Thyroid-Related Adverse Events in Melanoma Patients Treated With Pembrolizumab.

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