Systemic High-Dose Corticosteroid Treatment Does Not Improve the Outcome of Ipilimumab-Related Hypophysitis: A Retrospective Cohort Study
Systemic High-Dose Corticosteroid Treatment Does Not Improve the Outcome of Ipilimumab-Related Hypophysitis: A Retrospective Cohort Study
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DOI：
10.1158/1078-0432.ccr-14-2353
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发表时间：
2015-02-15
影响因子：
11.5
通讯作者：
Kaiser, Ursula B.
中科院分区：
文献类型：
--
作者：
Min, Le;Hodi, Frank Stephen;Kaiser, Ursula B.
用途：为了研究伊匹单抗相关垂体炎的发病和结局以及对全身性高剂量皮质类固醇（HDS）治疗的反应：分析了25例发生伊匹单抗相关垂体炎的患者的发病率、发病时间、消退时间、消退频率以及全身性HDS对临床结局的影响。为了计算发生率，从DFCI肿瘤学数据库中检索Dana-Farber癌症研究所（DFCI; Boston，MA）接受伊匹单抗治疗的转移性黑素瘤患者总数（187例）。使用Fisher精确检验进行皮质类固醇治疗组之间的比较。结果：伊匹单抗相关垂体炎的总发生率为13%，男性（16.1%）高于女性（8.7%）。开始伊匹单抗治疗后至垂体炎发作的中位时间为9周（范围，5-36周）。垂体增大、继发性肾上腺功能不全、继发性甲状腺功能减退、男性继发性性腺功能减退和低钠血症的消退率分别为73%、0%、64%、45%和92%。根据消退频率和消退时间测量，全身HDS治疗未改善垂体炎的结局。一年的总生存率在队列的患者为83%，而它是略高的患者谁没有收到HDS，有没有统计学意义的治疗arms.Conclusion：系统HDS治疗伊匹单抗相关的垂体炎患者可能没有指征。相反，垂体炎相关的激素缺乏症的支持性治疗与相应的激素替代应给予。(C)2014年AACR。
Purpose: To examine the onset and outcome of ipilimumab-related hypophysitis and the response to treatment with systemic high-dose corticosteroids (HDS).Experimental Design: Twenty-five patients who developed ipilimumab-related hypophysitis were analyzed for the incidence, time to onset, time to resolution, frequency of resolution, and the effect of systemic HDS on clinical outcome. To calculate the incidence, the total number (187) of patients with metastatic melanoma treated with ipilimumab at Dana-Farber Cancer Institute (DFCI; Boston, MA) was retrieved from the DFCI oncology database. Comparisons between corticosteroid treatment groups were performed using the Fisher exact test. The distributions of overall survival were based on the method of Kaplan-Meier.Results: The overall incidence of ipilimumab-related hypophysitis was 13%, with a higher rate in males (16.1%) than females (8.7%). The median time to onset of hypophysitis after initiation of ipilimumab treatment was 9 weeks (range, 5-36 weeks). Resolution of pituitary enlargement, secondary adrenal insufficiency, secondary hypothyroidism, male secondary hypogonadism, and hyponatremia occurred in 73%, 0%, 64%, 45%, and 92% of patients, respectively. Systemic HDS treatment did not improve the outcome of hypophysitis as measured by resolution frequency and time to resolution. One-year overall survival in the cohort of patients was 83%, and while it was slightly higher in patients who did not receive HDS, there was no statistically significant difference between treatment arms.Conclusion: Systemic HDS therapy in patients with ipilimumab-related hypophysitis may not be indicated. Instead, supportive treatment of hypophysitis-related hormone deficiencies with the corresponding hormone replacement should be given. (C) 2014 AACR.