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Article: Thyroid Immune-Related Adverse Events in Patients with Cancer Treated with anti-PD1/anti-CTLA4 Immune Checkpoint Inhibitor Combination: Clinical Course and Outcomes

TitleThyroid Immune-Related Adverse Events in Patients with Cancer Treated with anti-PD1/anti-CTLA4 Immune Checkpoint Inhibitor Combination: Clinical Course and Outcomes
Authors
Keywordshypothyroidism
immunotherapy
neoplasms
survival
thyroid diseases
Issue Date2021
PublisherElsevier Inc. The Journal's web site is located at https://www.sciencedirect.com/journal/endocrine-practice
Citation
Endocrine Practice, 2021, v. 27 n. 9, p. 886-893 How to Cite?
AbstractObjective: Thyroid immune-related adverse events (irAEs) have been reported to have prognostic significance among patients with cancer treated with anti-programmed cell death-1 (PD1) and anti-programmed death-ligand 1 monotherapies. We evaluated the clinical course and predictors of thyroid irAEs in relation to outcomes of patients with advanced cancer treated with combination anti-PD1/anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA4). Methods: We conducted a regional study and identified patients with advanced cancer who received ≥1 cycle of combination anti-PD1/anti-CTLA4 between 2015 and 2019 in Hong Kong. Thyroid function tests (TFTs) were monitored every 3 weeks. Thyroid irAE was defined by ≥2 abnormal TFTs after initiation of combination anti-PD1/anti-CTLA4 in the absence of other causes. Results: One hundred and three patients were included (median age: 59 years; 71.8% men). About 45% had prior anti-PD1 exposure. Upon median follow-up of 6.8 months, 17 patients (16.5%) developed thyroid irAEs, where 6 initially presented with thyrotoxicosis (overt, n = 4; subclinical, n = 2) and 11 with hypothyroidism (overt, n = 2; subclinical, n = 9). Eventually, 10 patients (58.8%) required continuous thyroxine replacement. Systemic steroid was not required in all cases. Prior anti-PD1 exposure (odds ratio, 3.67; 95% CI, 1.19-11.4; P = .024) independently predicted thyroid irAEs. Multivariable Cox regression analysis revealed that occurrence of thyroid irAEs was independently associated with better overall survival (adjusted hazard ratio, 0.34; 95% CI, 0.17-0.71; P = .004). Conclusion: Thyroid irAEs are common in routine clinical practice among patients with advanced cancer treated with anti-PD1/anti-CTLA4 combination and might have potential prognostic significance. Regular TFT monitoring is advised for timely treatment of thyroid irAEs to prevent potential morbidities. Copyright © 2021 AACE. Published by Elsevier Inc. All rights reserved.
Persistent Identifierhttp://hdl.handle.net/10722/300921
ISSN
2020 Impact Factor: 3.443
2020 SCImago Journal Rankings: 0.930
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorLui, DTW-
dc.contributor.authorLee, CH-
dc.contributor.authorTang, V-
dc.contributor.authorFong, CHY-
dc.contributor.authorLee, ACH-
dc.contributor.authorChiu, JWY-
dc.contributor.authorLeung, RCY-
dc.contributor.authorKwok, GGW-
dc.contributor.authorLi, BCW-
dc.contributor.authorCheung, TT-
dc.contributor.authorWoo, YC-
dc.contributor.authorLam, KSL-
dc.contributor.authorYau, T-
dc.date.accessioned2021-07-06T03:12:04Z-
dc.date.available2021-07-06T03:12:04Z-
dc.date.issued2021-
dc.identifier.citationEndocrine Practice, 2021, v. 27 n. 9, p. 886-893-
dc.identifier.issn1530-891X-
dc.identifier.urihttp://hdl.handle.net/10722/300921-
dc.description.abstractObjective: Thyroid immune-related adverse events (irAEs) have been reported to have prognostic significance among patients with cancer treated with anti-programmed cell death-1 (PD1) and anti-programmed death-ligand 1 monotherapies. We evaluated the clinical course and predictors of thyroid irAEs in relation to outcomes of patients with advanced cancer treated with combination anti-PD1/anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA4). Methods: We conducted a regional study and identified patients with advanced cancer who received ≥1 cycle of combination anti-PD1/anti-CTLA4 between 2015 and 2019 in Hong Kong. Thyroid function tests (TFTs) were monitored every 3 weeks. Thyroid irAE was defined by ≥2 abnormal TFTs after initiation of combination anti-PD1/anti-CTLA4 in the absence of other causes. Results: One hundred and three patients were included (median age: 59 years; 71.8% men). About 45% had prior anti-PD1 exposure. Upon median follow-up of 6.8 months, 17 patients (16.5%) developed thyroid irAEs, where 6 initially presented with thyrotoxicosis (overt, n = 4; subclinical, n = 2) and 11 with hypothyroidism (overt, n = 2; subclinical, n = 9). Eventually, 10 patients (58.8%) required continuous thyroxine replacement. Systemic steroid was not required in all cases. Prior anti-PD1 exposure (odds ratio, 3.67; 95% CI, 1.19-11.4; P = .024) independently predicted thyroid irAEs. Multivariable Cox regression analysis revealed that occurrence of thyroid irAEs was independently associated with better overall survival (adjusted hazard ratio, 0.34; 95% CI, 0.17-0.71; P = .004). Conclusion: Thyroid irAEs are common in routine clinical practice among patients with advanced cancer treated with anti-PD1/anti-CTLA4 combination and might have potential prognostic significance. Regular TFT monitoring is advised for timely treatment of thyroid irAEs to prevent potential morbidities. Copyright © 2021 AACE. Published by Elsevier Inc. All rights reserved.-
dc.languageeng-
dc.publisherElsevier Inc. The Journal's web site is located at https://www.sciencedirect.com/journal/endocrine-practice-
dc.relation.ispartofEndocrine Practice-
dc.subjecthypothyroidism-
dc.subjectimmunotherapy-
dc.subjectneoplasms-
dc.subjectsurvival-
dc.subjectthyroid diseases-
dc.titleThyroid Immune-Related Adverse Events in Patients with Cancer Treated with anti-PD1/anti-CTLA4 Immune Checkpoint Inhibitor Combination: Clinical Course and Outcomes-
dc.typeArticle-
dc.identifier.emailLui, DTW: dtwlui@hku.hk-
dc.identifier.authorityLui, DTW=rp02803-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.eprac.2021.01.017-
dc.identifier.pmid33581327-
dc.identifier.scopuseid_2-s2.0-85109025604-
dc.identifier.hkuros323097-
dc.identifier.volume27-
dc.identifier.issue9-
dc.identifier.spage886-
dc.identifier.epage893-
dc.identifier.isiWOS:000692871600005-
dc.publisher.placeUnited States-

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