■免疫检查点抑制剂(ICIs)在肿瘤学中是革命性的,但可能会引起免疫相关(IR)副作用,如垂体炎。用抗-PD-(L)1、抗-CTLA-4或抗-CLTA-4/PD-1治疗可诱发垂体炎,但对临床表现或需要不同治疗的差异知之甚少。我们分析了抗PD-(L)1,抗CTLA-4和抗CTLA-4/PD-1诱导的垂体炎的差异。
■回顾性分析67例患者(27例抗PD-(L)1,6例抗CLTA-4和34例抗CTLA-4/PD-1诱发的垂体炎)。
■抗PD(L)-1)治疗后,开始ICIs和IR-垂体炎之间的中位时间更长(抗CTLA-4和抗CTLA-4/PD-1治疗后22周和14周,分别)。大多数患者(>90%)出现非典型的抱怨,如疲劳,恶心,和肌肉抱怨。头痛,TSH或LH/FSH缺乏在抗CTLA-4和抗CLTA-4/PD-1与抗PD-(L)1引起的垂体炎中更为常见(83%和58%对8%,67%和41%对11%,83%和48%对7%,分别)。MRI上的垂体异常(垂体炎或继发性空蝶鞍综合征)仅在接受抗CTLA-4或抗CTLA-4/PD-1治疗的患者中可见。从TSH中恢复,92%的患者有LH/FSH和ACTH缺乏症,70%和0%的患者在平均14天和104天后,分别,在接受或未接受高剂量类固醇的患者之间没有差异。
■IR-垂体炎的临床表现因ICIs的类型而异。MRI异常仅见于抗CTLA-4或抗CTLA-4/PD-1诱导的垂体炎。内分泌恢复见于LH/FSH和TSH缺乏,但未见于ACTH缺乏,与皮质类固醇剂量无关。
UNASSIGNED: Immune checkpoint inhibitors (ICIs) are revolutionary in oncology but may cause immune-related (IR) side effects, such as
hypophysitis. Treatment with anti-PD-(L)1, anti-CTLA-4 or anti-CLTA-4/PD-1 may induce
hypophysitis, but little is known about the differences in clinical presentation or need for different treatment. We analyzed the differences of anti-PD-(L)1, anti-CTLA-4 and anti-CTLA-4/PD-1 induced
hypophysitis.
UNASSIGNED: retrospective analysis of 67 patients (27 anti-PD-(L)1, 6 anti-CLTA-4 and 34 anti-CTLA-4/PD-1 induced hypophysitis).
UNASSIGNED: The median time between starting ICIs and IR-
hypophysitis was longer after anti-PD(L)-1) therapy (22 weeks versus 11 and 14 weeks after anti-CTLA-4 and anti-CTLA-4/PD-1 therapy, respectively). The majority of patients (>90%), presented with atypical complaints such as fatigue, nausea, and muscle complaints. Headache, TSH or LH/FSH deficiency were more common in anti-CTLA-4 and anti-CLTA-4/PD-1 versus anti-PD-(L)1 induced hypophysitis (83% and 58% versus 8%, 67% and 41% versus 11%, and 83% and 48% versus 7%, respectively). Pituitary abnormalities on MRI (hypophysitis or secondary empty sella syndrome) were only seen in patients receiving anti-CTLA-4 or anti-CTLA-4/PD-1 therapy. Recovery from TSH, LH/FSH and ACTH deficiency was described in 92%, 70% and 0% of patients after a mean period of 14 and 104 days, respectively, and did not differ between patients who did or did not receive high-dose steroids.
UNASSIGNED: The clinical presentation of IR-hypophysitis varies depending on the type of ICIs. MRI abnormalities were only seen in anti-CTLA-4 or anti-CTLA-4/PD-1 induced
hypophysitis. Endocrine recovery is seen for LH/FSH and TSH deficiency but not for ACTH deficiency, irrespective of the corticosteroid dose.