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Ipilimumab‐induced hypophysitis in melanoma patients: an A ustralian case series
Author(s) -
Lam T.,
Chan M. M. K.,
Sweeting A. N.,
De Sousa S. M. C.,
Clements A.,
Carlino M. S.,
Long G. V.,
Tonks K.,
Chua E.,
Kefford R. F.,
Chipps D. R
Publication year - 2015
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.12819
Subject(s) - medicine , hypophysitis , ipilimumab , levothyroxine , pembrolizumab , immunotherapy , thyroid , cancer , hormone , pituitary gland
Background Ipilimumab ( Y ervoy; B ristol‐ M yers S quibb) is a novel fully humanised monoclonal antibody that blocks cytotoxic T ‐lymphocyte antigen 4, an immune checkpoint molecule, to augment anti‐tumour T ‐cell responses. It is associated with significant immune‐related side‐effects including hypophysitis. Aim We reviewed the clinical and biochemical characteristics of 10 patients with ipilimumab‐induced hypophysitis ( IH ), and developed guidelines for the early detection and management of IH based on our experiences at three major teaching hospitals in Sydney. Methods All patients were evaluated at the C rown P rincess M ary C ancer C entre and D epartment of E ndocrinology, W estmead H ospital, D epartment of E ndocrinology, R oyal P rince A lfred H ospital, the M elanoma I nstitute A ustralia and M acarthur C ancer T herapy C entre, C ampbelltown H ospital from 2010 to 2014. Relevant data were extracted by review of medical records. Main outcome measures included clinical features, hormone profile and radiological findings associated with IH , and presence of pituitary recovery. Results Ten patients were identified with IH . In four patients who underwent monitoring of plasma cortisol, there was a fall in levels in the weeks prior to presentation. The pituitary–adrenal and pituitary–thyroid axes were affected in the majority of patients, with the need for physiological hormone replacement. Imaging abnormalities were identified in five of 10 patients, and resolved without high‐dose glucocorticoid therapy. To date, all patients remain on levothyroxine and hydrocortisone replacement, where appropriate. Conclusions There is significant morbidity associated with development of IH . We suggest guidelines to assist with early recognition and therapeutic intervention.