Recurrence of Hypophysitis After Immune Checkpoint Inhibitor Rechallenge.
Recurrence of Hypophysitis After Immune Checkpoint Inhibitor Rechallenge.
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DOI：
10.1093/oncolo/oyac220
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发表时间：
2022-12-09
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--
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免疫检查点抑制剂（ICI）诱导的垂体炎是一种免疫介导的垂体炎症，往往会导致长期的垂体缺陷。ICI诱导的垂体炎的治疗包括皮质类固醇治疗急性炎症和长期激素替代治疗不可逆的垂体细胞损伤。我们报告一例复发性垂体炎后ICI再激发转移性黑色素瘤。一名患有复发性转移性黑色素瘤伴肾上腺、骨盆和腹股沟转移的33岁女性在用易普利姆玛和纳武单抗治疗期间发生复发性垂体炎，其在>5年后再次激发时复发。在这两个病例中，头痛是最显著的症状，脑MRI显示垂体肿大和水肿，没有转移的证据。中枢性肾上腺皮质功能不全和占位效应引起的症状用急性大剂量皮质类固醇和长期替代皮质类固醇治疗。基于复发和继续类固醇治疗的对症治疗失败，停止ICI。该病例表明，垂体炎可能在ICI再激发时复发，挑战了慢性、不可逆irAE不太可能复发或发作的传统假设。ICI诱导的损伤或对先前未受影响的细胞的额外损伤后垂体细胞的再生潜力可能比以前认识到的更容易想象。需要对ICI诱导的内分泌病复发的可能性进行进一步研究。本文报告一例转移性黑色素瘤免疫检查点抑制剂再激发后复发性垂体炎。
Immune checkpoint inhibitor (ICI)-induced hypophysitis is an immune-mediated pituitary inflammation that tends to cause long-term pituitary deficiency. Management of ICI-induced hypophysitis includes corticosteroids for acute inflammation and long-term hormone replacement due to irreversible pituitary cell damage. We report a case of recurrent hypophysitis following ICI rechallenge for metastatic melanoma. A 33-year-old woman with recurrent metastatic melanoma with adrenal, pelvic, and inguinal metastases developed recurrent hypophysitis during treatment with ipilimumab and nivolumab which recurred with rechallenge >5 years later. In both cases, headache was the most notable symptom and brain MRI showed pituitary enlargement and edema without evidence of metastases. Central adrenal insufficiency and symptoms caused by mass effect were treated with acute high-dose corticosteroids and long-term replacement corticosteroids. Based on recurrence and failure of symptomatic treatment with continued steroid treatment, ICI was discontinued. This case illustrates that hypophysitis may recur with ICI rechallenge, challenging traditional assumptions that chronic, irreversible irAEs are unlikely to recur or flare. The regenerative potential of pituitary cells after ICI-induced damage or additional damage to previously unaffected cells may be more conceivable than previously realized. Additional research on the potential for recurrent ICI-induced endocrinopathies are needed. This article reports a case of recurrent hypophysitis following immune checkpoint inhibitor rechallenge for metastatic melanoma.
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影响因子：
4.7
作者：
Jessel S;Weiss SA;Austin M;Mahajan A;Etts K;Zhang L;Aizenbud L;Perdigoto AL;Hurwitz M;Sznol M;Herold KC;Kluger HM
通讯作者：
Kluger HM
影响因子：
17.1
作者：
Iwama, Shintaro;De Remigis, Alessandra;Caturegli, Patrizio
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影响因子：
7.4
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Laurent S;Queirolo P;Boero S;Salvi S;Piccioli P;Boccardo S;Minghelli S;Morabito A;Fontana V;Pietra G;Carrega P;Ferrari N;Tosetti F;Chang LJ;Mingari MC;Ferlazzo G;Poggi A;Pistillo MP
通讯作者：
Pistillo MP
DOI：
10.1038/s41571-022-00600-w
发表时间：
2022-04
期刊：
Nature reviews. Clinical oncology
影响因子：
--
作者：
Johnson DB;Nebhan CA;Moslehi JJ;Balko JM
通讯作者：
Balko JM
影响因子：
10.9
作者：
Thapi, Sahityasri;Leiter, Amanda;Gallagher, Emily J.
通讯作者：
Gallagher, Emily J.