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International Urology and Nephrology

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Open Access 05-06-2023 | Hypophysitis | Urology - Original Paper

Endocrine immune-related adverse events in patients with metastatic renal and urothelial cancer treated with immune checkpoint-inhibitors

Authors: Immanuel Augustin Oppolzer, Josef Riester, Roland Büttner, Maximilian Burger, Marco Julius Schnabel

Published in: International Urology and Nephrology | Issue 8/2023

Abstract

Purpose

To evaluate the incidence, diagnosis and treatment of immune-related adverse events (e-irAE) of checkpoint inhibition (ICI) in metastatic urothelial carcinoma (mUC) and metastatic renal cell carcinoma (mRCC).

Methods

A retrospective, single-center study was conducted to identify a cohort that received ICI for mUC or mRCC. e-irAE were classified according to the CTCAE V.5.0. Patients received ICI for mUC or mCC between 01/2017 and 03/2021. A retrospective chart review was performed. T-Test, the chi-squared test, and Fisher's exact test were performed.

Results

102 Patients received ICI [mUC: 40 (39%), mRCC: 62 (61%)]. 64 (63%) received an ICI monotherapy, 27 (27%) a dual ICI therapy, 11 (11%) a combination with VEGFi. e-irAE occurred in 19 (19%) patients [grade 1–2: 17 (84%), grade 3: 3 (16%)]. The median time until e-irAE was 42 days (range 11–211 days). 14 Patients developed thyroidism (14%), 4 (4%) a hypophysitis, 1 (1%) an adrenal insufficiency (AI). 7 patients (7%) had to discontinue ICI therapy [hypophysitis (100%), AI (100%), thyroidism (14%)]. 6 (86%) received cortisone. After a median range of 34 days 5 patients (71%) restarted ICI therapy. All patients (n = 4) with hypophysitis continued ICI [4 (100%) prednisone, 3 (75%) levothyroxine]. 11 (79%) presented with hyperthyroidism. 4 (37%) needed therapy (1 (7%) prednisone, 3 (21%) thiamazole, 2 (14%) beta blocker). The 9 (64%) patients with hypothyroidism received levothyroxine. Hypophysitis appears only on dual ICI (CTLA-4/PD-1) inhibition (p 0.007).

Conclusion

This study shows the importance of adequate diagnosis and therapy of e-irAEs.

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Title: Endocrine immune-related adverse events in patients with metastatic renal and urothelial cancer treated with immune checkpoint-inhibitors
Authors: Immanuel Augustin Oppolzer
Josef Riester
Roland Büttner
Maximilian Burger
Marco Julius Schnabel
Publication date: 05-06-2023
Publisher: Springer Netherlands
Keywords: Hypophysitis
Hyperthyroidism
Checkpoint Inhibitors
Kidney Cancer
Kidney Cancer
Kidney Cancer
Urothelial Cancer
Urothelial Cancer
Hypothyroidism
Published in: International Urology and Nephrology / Issue 8/2023
Print ISSN: 0301-1623
Electronic ISSN: 1573-2584
DOI: https://doi.org/10.1007/s11255-023-03635-9

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