Endocrine adverse events related to immune-oncology agents: retrospective experience of a single institution
Endocrine adverse events related to immune-oncology agents: retrospective experience of a single institution
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DOI：
10.21037/tlcr.2019.12.17
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发表时间：
2020-02-01
影响因子：
4
通讯作者：
Etxaniz, Olatz
中科院分区：
文献类型：
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作者：
Espana, Sofia;Montes de Oca, Alejandra Perez;Etxaniz, Olatz
背景：免疫肿瘤药物（IOA）代表了几种实体瘤（ST）治疗的一个转折点。虽然其毒性优于其他治疗方法，但IOA相关免疫相关不良事件（IR-AE），其中内分泌相关AE尤为突出。我们回顾性评估了一组接受IOA治疗的多例ST患者中内分泌IR-AE的发生情况。此外，我们评估了生存可能性与IR-AE发生之间的相关性。方法：收集2013 - 2017年260例经IOA治疗的ST患者的临床、分子特征、疗效及AE数据。我们排除了既往病史或治疗可能影响甲状腺检查结果的患者。结果：肺癌是最常见的诊断（70.2%）。18.1%的患者出现EIR-AE（共38例），其中甲状腺功能减退、甲状腺功能亢进、垂体功能紊乱和1型糖尿病分别占60.5%、21.1%、15.8%和2.6%。EIR-AE主要与纳武单抗、纳武单抗联合伊匹单抗相关（41.2%和26.5%），出现在中位治疗4.2个周期后。65.8%的患者需要特异性治疗。与未经历EIR-AE的患者相比，经历EIR-AE的患者在无进展生存期（PFS）和总生存期（OS）方面存在显著差异[PFS: 56.7 (NC-NC) vs. 27.7（14.3-41.3）个月，P=0.008；操作系统:数控(NC-NC)和31.4(20.7 - -42.1)个月,P = 0.001)。结论：本研究中EIR-AE的发生率与其他系列相似。与没有发生EIR-AE的患者相比，发生EIR-AE的患者预后可能更好。
Background: Immune-oncology agents (IOA) represent a turning point in the treatment of several solid tumors (ST). Although their toxicity compares favorably with other treatments, IOA associate immune-related adverse events (IR-AE), among which endocrine-related AE stand out. We retrospectively evaluated the occurrence of endocrine (E) IR-AE in a cohort of patients with several ST treated with IOA. In addition, we assessed the correlation between likelihood of survival and the occurrence of IR-AE.Methods: We collected data on clinical and molecular characteristics, efficacy and AE of 260 patients with ST treated with IOA from 2013 to 2017. We excluded patients with prior conditions or treatments potentially affecting thyroid test results.Results: Lung cancer was the most prevalent diagnosis (70.2%). EIR-AE appeared in 18.1% of patients (total of 38 EIR-AE) and consisted of hypothyroidism, hyperthyroidism, pituitary disorders and type 1 diabetes mellitus in 60.5%, 21.1%, 15.8% and 2.6% of patients, respectively. EIR-AE were associated mainly to nivolumab, nivolumab plus ipilimumab (41.2% and 26.5%) and appeared after a median of 4.2 cycles of treatment. Specific therapy was required in 65.8% patients. There were significant differences in both progression-free survival (PFS) and overall survival (OS) for patients who experienced EIR-AE compared to those who did not [PFS: 56.7 (NC-NC) vs. 27.7 (14.3-41.3) months, P=0.008; OS: NC (NC-NC) vs. 31.4 (20.7-42.1) months, P=0.001].Conclusions: The incidence of EIR-AE in our study is similar to other series. Patients who develop EIR-AE might have a better prognosis compared to those who do not experience them.