Baseline serum TSH levels predict the absence of thyroid dysfunction in cancer patients treated with immunotherapy.
Baseline serum TSH levels predict the absence of thyroid dysfunction in cancer patients treated with immunotherapy.
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DOI：
10.1007/s40618-020-01480-6
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发表时间：
2021-08
影响因子：
5.4
通讯作者：
Castagna MG
中科院分区：
文献类型：
--
作者：
Brilli L;Danielli R;Campanile M;Secchi C;Ciuoli C;Calabrò L;Pilli T;Cartocci A;Pacini F;Di Giacomo AM;Castagna MG
针对免疫检查点的免疫疗法在几种类型的癌症中显著改善了转移性和辅助性环境中的存活率。甲状腺功能障碍是报告的最常见的内分泌不良事件。有发生甲状腺功能障碍风险的患者仍有待确定。我们的目的是确定免疫治疗期间甲状腺功能障碍发展的预测因素。这是一项回顾性研究，共纳入68例接受免疫检查点抑制剂（ICI）治疗转移性或不可切除的晚期癌症的患者。大多数患者接受抗PD 1药物单药治疗或与抗CTLA 4抑制剂联合治疗。在开始免疫治疗前和治疗期间，对甲状腺功能和抗甲状腺抗体进行了评价。在入组研究时，还对一个亚组的患者进行了甲状腺超声检查。68例患者中有11例（16.1%）发生了免疫相关的明显甲状腺功能障碍。通过ROC曲线分析，我们发现基线时血清TSH临界值为1.72 mUI/l，在识别无明显甲状腺功能障碍的患者方面具有良好的诊断准确性（NPV = 100%，p = 0.0029）。在多变量分析中，ICIs治疗前TSH和阳性抗甲状腺抗体（ATAbs）水平与免疫治疗期间明显甲状腺功能障碍的发生独立相关（分别为p = 0.0001和p = 0.009）。治疗前血清TSH和ATAbs水平可能有助于识别原发性甲状腺功能障碍的高风险患者。我们的研究建议指导适当的及时筛查和个性化的管理甲状腺功能障碍的患者接受ICI治疗。
Immunotherapy against immune checkpoints has significantly improved survival both in metastatic and adjuvant setting in several types of cancers. Thyroid dysfunction is the most common endocrine adverse event reported. Patients who are at risk of developing thyroid dysfunction remain to be defined. We aimed to identify predictive factors for the development of thyroid dysfunction during immunotherapy. This is a retrospective study including a total of 68 patients who were treated with immune checkpoint inhibitors (ICIs) for metastatic or unresectable advanced cancers. The majority of patients were treated with anti-PD1 drugs in monotherapy or in combination with anti-CTLA4 inhibitors. Thyroid function and anti-thyroid antibodies, before starting immunotherapy and during treatment, were evaluated. Thyroid ultrasound was also performed in a subgroup of patients at the time of enrolment in the study. Eleven out of 68 patients (16.1%) developed immune-related overt thyroid dysfunction. By ROC curve analysis, we found that a serum TSH cut-off of 1.72 mUI/l, at baseline, had a good diagnostic accuracy in identifying patients without overt thyroid dysfunction (NPV = 100%, p = 0.0029). At multivariate analysis, both TSH and positive anti-thyroid antibodies (ATAbs) levels, before ICIs treatment, were independently associated with the development of overt thyroid dysfunction during immunotherapy (p = 0.0001 and p = 0.009, respectively). Pre-treatment serum TSH and ATAbs levels may help to identify patients at high risk for primary thyroid dysfunction. Our study suggests guidance for an appropriate timely screening and for a tailored management of thyroid dysfunctions in patients treated with ICIs.
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影响因子：
6.6
作者：
Basak, Edwin A.;van der Meer, Jan W. M.;Medici, Marco
通讯作者：
Medici, Marco
影响因子：
5.7
作者：
Kimbara S;Fujiwara Y;Iwama S;Ohashi K;Kuchiba A;Arima H;Yamazaki N;Kitano S;Yamamoto N;Ohe Y
通讯作者：
Ohe Y
影响因子：
2.9
作者：
Olsson-Brown, Anna;Lord, Rosemary;Pirmohamed, Munir
通讯作者：
Pirmohamed, Munir
DOI：
10.1210/jc.2016-2300
发表时间：
2016-11
期刊：
The Journal of clinical endocrinology and metabolism
影响因子：
--
作者：
de Filette J;Jansen Y;Schreuer M;Everaert H;Velkeniers B;Neyns B;Bravenboer B
通讯作者：
Bravenboer B
影响因子：
4.4
作者：
Girotra M;Hansen A;Farooki A;Byun DJ;Min L;Creelan BC;Callahan MK;Atkins MB;Sharon E;Antonia SJ;West P;Gravell AE;Investigational Drug Steering Committee (IDSC) Immunotherapy Task Force collaboration
通讯作者：
Investigational Drug Steering Committee (IDSC) Immunotherapy Task Force collaboration