1. Higher baseline TSH levels predict early hypothyroidism during cancer immunotherapy
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Martin Schlumberger, Francesca Sessa, Valentina Damiano, Tommaso Porcelli, C. Gambale, Domenico Salvatore, Michele Klain, E. Matano, Cristina Luongo, R. Morra, Luongo, C, Morra, R, Gambale, C, Porcelli, T, Sessa, F, Matano, E, Damiano, V, Klain, M, Schlumberger, M, and Salvatore, D
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Male ,endocrine system diseases ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Thyrotropin ,Kaplan-Meier Estimate ,Thyroid immuno-related adverse events ,Thyroid Function Tests ,Gastroenterology ,Endocrinology ,Antineoplastic Agents, Immunological ,Retrospective Studie ,Risk Factors ,Neoplasms ,Medicine ,Euthyroid ,Immune Checkpoint Inhibitors ,Thyrotoxicosi ,Anti-thyroid antibodie ,Aged, 80 and over ,biology ,Thyroid ,Middle Aged ,Anti-thyroid autoantibodies ,Progression-Free Survival ,medicine.anatomical_structure ,Anti-thyroid antibodies ,Thyrotoxicosis ,Treatment Outcome ,Original Article ,Female ,Survival Analysi ,Immunotherapy ,Antibody ,Thyroid function ,hormones, hormone substitutes, and hormone antagonists ,Human ,Adult ,medicine.medical_specialty ,endocrine system ,Immune Checkpoint Inhibitor ,Hypothyroidism ,Internal medicine ,Endocrine system ,Humans ,Adverse effect ,Aged ,Retrospective Studies ,Thyroid immuno-related adverse event ,business.industry ,Risk Factor ,Survival Analysis ,Thyroid Function Test ,biology.protein ,Neoplasm ,business - Abstract
Background and purposeImmune 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 methodsWe 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.ResultsIn 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.ConclusionsBaseline 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.
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- 2021