Prevalence, risk factors and features of the course of thyroid dysfunction induced by immunotherapy for cancer
Background: The use of immune checkpoint inhibitors (ICPIs) is associated with the risk of endocrine adverse events (AEs).K.Yu. Zherebchikova, M.O. Soltakhanova, Yu.P. Sych, M.I. Sekacheva, V.V. Fadeev, M.V. Dolidze, G.A. Repetunov, A.A. Vilensky
Objective: Determination of the incidence, assessment of the structure, timing and predictors of development of immune related thyroid pathology during therapy with anti-PD1/ PDL1 drugs.
Materials and methods: The prospective study involved 235 patients aged 23 to 88 years without thyroid dysfunction, who were first treated with drugs from the anti-PD1/ PDL1 group for various types of malignant neoplasms. Thyroid function was assessed initially and every month throughout the treatment period. The average follow-up period was 52 weeks. The structure, incidence, time of manifestation and predictors of immune related thyroidopathy were assessed.
Results: Immune related thyroiditis was detected in 22.1% of patients, in half the pathology manifested itself in the thyrotoxic phase, in the other half - in the hypothyroid phase. The average time from the start of treatment to the development of thyroidopathy was 7.75 weeks. No predictors of the development of immune related thyroid pathology were identified. All patients with immune related thyroiditis developed manifest hypothyroidism as an outcome. All patients with hypothyroidism were prescribed replacement therapy with levothyroxine, and beta-blockers in the thyrotoxic phase of thyroiditis. In most cases, thyroiditis was asymptomatic and did not require cancellation or suspension of ICTI therapy.
Conclusion: The incidence of immune related thyroiditis was 22.1%. Further studies are required to more accurately identify predictors of the development of immune related thyroid pathology in order to determine the optimal management tactics for this group of patients.
Keywords
immune checkpoint inhibitors
immune related thyroiditis
hypothyroidism
adverse events
About the Authors
Kristina Yu. Zherebchikova, Teaching Assistant at Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; k.y.zherebchikova@gmail.com, ORCID: https://orcid.org/0000-0003-0292-5907 (corresponding author)Madina O. Soltakhanova, Clinical Resident, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; ORCID: https://orcid.org/0009-0004-2816-0943
Yulia P. Sych, Cand. Sci. (Med.), Associate Professor at the Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; ORCID: https://orcid.org/0000-0002-7000-0095
Marina I. Sekacheva, Dr. Sci. (Med.), Professor, Director of the Institute of Personalized Medicine, Head of the Center for Personalized Oncology, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; ORCID: https://orcid.org/0000-0003-0015-7094
Valentin V. Fadeev, Dr. Sci. (Med.), Professor, Corresponding Member of the Russian Academy of Medical Sciences, Head of the Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; ORCID: https://orcid.org/0000-0002-2504-7468
Marina V. Dolidze, Clinical Resident, Voronezh State Medical University named after N.N. Burdenko, Voronezh, Russia; ORCID: https://orcid.org/0009-0003-5663-3448
Georgy A. Repetunov, Endocrinologist, Endocrinology Dispensary of the Moscow Healthcare Department, Russia; ORCID: https://orcid.org/0009-0009-4108-3782
Aleksey A. Vilensky, Head of the Department of Antitumor Drug Therapy of the Medical Scientific and Educational Center, Lomonosov Moscow State University, Moscow, Russia; ORCID: https://orcid.org/0000-0002-3094-7671
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