scholarly journals Incidence of Thyroid Function Test Abnormalities in Patients Receiving Immune‐Checkpoint Inhibitors for Cancer Treatment

2018 ◽  
Vol 23 (10) ◽  
pp. 1236-1241 ◽  
Author(s):  
Nisha Subhash Patel ◽  
Anais Oury ◽  
Gregory A. Daniels ◽  
Lyudmila Bazhenova ◽  
Sandip Pravin Patel
Keyword(s):  
Cancer Treatment ◽  
Thyroid Function ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Thyroid Function Test ◽  
Function Test

scholarly journals OR18-06 Thyroid Function Test Abnormalities Secondary to Immune-Checkpoint Inhibitors: A Marker of Survival?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Joana Lima Ferreira ◽  
Cláudia Fernandes Costa ◽  
Sofia Castro ◽  
Joana Oliveira ◽  
Ana Paula Santos ◽  
...  
Keyword(s):  
Overall Survival ◽  
Thyroid Function ◽  
Immune Checkpoint Inhibitors ◽  
Thyroid Dysfunction ◽  
Checkpoint Inhibitors ◽  
Tumor Staging ◽  
Thyroid Function Test ◽  
Control Group ◽  
Function Test ◽  
Primary Neoplasm

Abstract Immune-checkpoint inhibitors (ICI) are monoclonal antibodies which target molecules to enhance antitumor response. Several adverse events have been described and the major ICI-related endocrinopathies are thyroid dysfunction and hypophysitis. Its occurrence has been associated with increased survival. A retrospective study of adult patients treated with ICI between March 2014 and September 2019 at an oncologic centre was performed to evaluate the impact of thyroid function test abnormalities (TFTA) in their prognosis. We excluded patients without regular monitoring of thyroid function, with previous thyroid or pituitary disease (including medical and surgical treatments), previous head/neck radiotherapy and who performed only one ICI cycle. Clinical data of all patients were examined independently by two Endocrinologists. Survival analysis was performed using the Kaplan-Meier method. Cox regression was used to evaluate associations between the occurrence of TFTA and the outcome of overall survival (OS). It was adjusted for sex, age, primary neoplasm, tumor staging and ICI. All analyses were performed using IBM-SPSS v.25 and a level of significance α=0.05 was noted. We included 161 of 205 patients, with a median age of 65 years [Interquartile range (IQR) 15] and 67% male. Most patients had melanoma (52%) and lung cancer (43%). Globally, 86, 59 and 25 patients were under pembrolizumab, nivolumab and ipilimumab, respectively. Median duration of ICI treatment was 4.4 months (IQR 7.7) and median total follow-up was 11.4 months (IQR 11.2). New onset TFTA was diagnosed in 18% of patients, at median age of 65 years (IQR 20) and 55% male. Almost half (45%) had primary hypothyroidism, 28% had central hypothyroidism and 13.8% had biphasic thyroiditis and thyrotoxicosis, each. Most TFTA (79%) occurred under pembrolizumab and nivolumab. Grade 2 CTCAE was the most frequently reported. None of the events led to ICI suspension. Patients with TFTA underwent a significant higher number of ICI cycles than control group [median 11 cycles (IQR 20) vs 7 (IQR 11), p=0.017] and had a higher period under ICI (median of 7.6 months (IQR 13.8) vs 4.2 (IQR 7.7), p=0.026). Comparison between TFTA patients and control group did not reveal statistical differences in patients’ age and sex, primary neoplasm, tumor staging and ICI. Overall survival was significantly higher in patients that developed TFTA during treatment with ICI, comparing to the control group (mean OS 3.62 years vs 1.92 years, p=0.033). The risk of mortality was higher for the control group, approximately 3 times, considering the adjustment for the covariates (HR 2.94, 95%CI=1.18 to 7.34, p=0.021). Overall survival was not affected by the covariates. Our study shows that patients under ICI that develop primary or central thyroid dysfunction had an improved survival. In these patients, the occurrence of TFTA could be a marker of a better response to ICI.

scholarly journals Myocarditis Surveillance With High-Sensitivity Troponin I During Cancer Treatment With Immune Checkpoint Inhibitors

2021 ◽  
Vol 3 (1) ◽  
pp. 137-139
Author(s):  
Sarah Waliany ◽  
Joel W. Neal ◽  
Sunil Reddy ◽  
Heather Wakelee ◽  
Sumit A. Shah ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Troponin I ◽  
Checkpoint Inhibitors ◽  
High Sensitivity ◽  
High Sensitivity Troponin

Immune checkpoint inhibitors: Significant advancements in non–small cell lung cancer treatment

2021 ◽  
Author(s):  
Ashley E Glode ◽  
Megan B May
Keyword(s):  
Lung Cancer ◽  
Cancer Treatment ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Small Cell ◽  
Novel Therapies ◽  
Small Cell Lung

Abstract Purpose This article explores the efficacy, toxicity, place in therapy, and considerations for use of recently approved immune checkpoint inhibitors (ICIs) in the treatment of non–small cell lung cancer (NSCLC). Summary Lung cancer is the leading cause of cancer mortality in the United States and is responsible for more cancer-related deaths than breast, prostate, and colorectal cancer combined. The landscape for lung cancer treatment is evolving with the approval of new and exciting novel therapies. Within the last decade numerous ICIs have been approved for use in the management of the most common subtype of lung cancer, NSCLC. The ICI agents currently approved by the Food and Drug Administration (FDA) for use in NSCLC include ipilimumab, pembrolizumab, nivolumab, durvalumab, and atezolizumab. These agents are approved for specific indications; therefore, they are not interchangeable. This review focuses on the landmark trials that led to each FDA-approved indication, as well as common toxicities seen with use of these agents. It also discusses the use of ICIs in special populations and unique considerations prior to initiation of treatment with these novel therapies in a patient with NSCLC. Conclusion ICIs can provide a breakthrough treatment option for the management of NSCLC and are rapidly being adopted into clinical practice. It is important to be familiar with appropriate selection of an ICI therapy option for each patient based on approved indication, unique considerations, and anticipated toxicities.

scholarly journals Prognostic Factors and Biomarkers of Responses to Immune Checkpoint Inhibitors in Lung Cancer

2019 ◽  
Vol 20 (19) ◽  
pp. 4931 ◽  
Author(s):  
Andrea Bianco ◽  
Fabio Perrotta ◽  
Giusi Barra ◽  
Umberto Malapelle ◽  
Danilo Rocco ◽  
...  
Keyword(s):  
Lung Cancer ◽  
T Cell ◽  
Cancer Treatment ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
T Cell Subsets ◽  
Durable Response ◽  
Lung Cancer Treatment ◽  
The Impact

Manipulation of the immune response is a game changer in lung cancer treatment, revolutionizing management. PD1 and CTLA4 are dynamically expressed on different T cell subsets that can either disrupt or sustain tumor growth. Monoclonal antibodies (MoAbs) against PD1/PDL1 and CTLA4 have shown that inhibitory signals can be impaired, blocking T cell activation and function. MoAbs, used as both single-agents or in combination with standard therapy for the treatment of advanced non-small cell lung cancer (NSCLC), have exhibited advantages in terms of overall survival and response rate; nivolumab, pembrolizumab, atezolizumab and more recently, durvalumab, have already been approved for lung cancer treatment and more compounds are in the pipeline. A better understanding of signaling elicited by these antibodies on T cell subsets, as well as identification of biological determinants of sensitivity, resistance and correlates of efficacy, will help to define the mechanisms of antitumor responses. In addition, the relevance of T regulatory cells (Treg) involved in immune responses in cancer is attracting increasing interest. A major challenge for future research is to understand why a durable response to immune checkpoint inhibitors (ICIs) occurs only in subsets of patients and the mechanisms of resistance after an initial response. This review will explore current understanding and future direction of research on ICI treatment in lung cancer and the impact of tumor immune microenvironment n influencing clinical responses.

scholarly journals Comparative risk of serious and fatal treatment-related adverse events caused by 19 immune checkpoint inhibitors used in cancer treatment: a network meta-analysis

2020 ◽  
Vol 12 ◽  
pp. 175883592094092 ◽  
Author(s):  
Tingting Liu ◽  
Bo Jin ◽  
Jun Chen ◽  
Hui Wang ◽  
Shuiyu Lin ◽  
...  
Keyword(s):  
Adverse Events ◽  
Cancer Treatment ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Meta Analysis ◽  
Combinatorial Therapy ◽  
Grade 5 ◽  
Comparative Risk ◽  
Grade 3

Background: This network meta-analysis assessed the comparative risk of grade 3–5 and grade 5 treatment-related adverse events (TRAEs) for immune checkpoint inhibitors (ICIs), either alone or in combination with other modalities, for cancer treatment. Methods: PubMed, Embase, Cochrane Library, Web of Science, and recent predominant oncology congresses were searched for relevant phase II and phase III randomized controlled trials (RCTs). As outcomes, grade 3–5, and grade 5 TRAE outcomes were reported as odds ratios and 95% confidence intervals. Results: In 67 RCTs involving 36,422 patients and 19 ICIs, the incidence of grade 3–5 and grade 5 TRAEs was 17.9% and 0.8% with ICI monotherapy and 46.3% and 1.4%, respectively, with combinatorial therapy. Pneumonitis was the most common cause of grade 5 TRAEs following either monotherapy (16.3%) or combinatorial therapy (11.4%). Regarding grade 3–5 TRAEs, atezolizumab + chemotherapy (CT) and antiangiogenic therapy (AT) (atezolizumab + CAT), pembrolizumab + CT, ipilimumab + CT, and atezolizumab + CT were more toxic than any ICI monotherapy, pembrolizumab or nivolumab + radiotherapy (RT), and ICIs dual therapy (durvalumab + tremelimumab and nivolumab + ipilimumab). Tremelimumab, ipilimumab, durvalumab, and pembrolizumab were, however, associated with higher grade 5 TRAEs than combinatorial treatments. Atezolizumab + CAT was the most toxic and nivolumab + RT was the least toxic of combinatorial treatments; among monotherapies, tremelimumab and avelumab were the most and least toxic, respectively. The toxicity ranking changed with type of grade 3–5 TRAEs. Conclusions: Compared with combinatorial therapy, ICI monotherapy caused lower grade 3–5 TRAEs, but some monotherapies resulted in a higher incidence of fatal TRAEs. Atezolizumab + CAT and nivolumab + RT were the most and least toxic of combinatorial treatments, respectively, and tremelimumab and avelumab were the most and least toxic of the monotherapies, respectively.

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