Toxicités endocriniennes des inhibiteurs de checkpoints immunitaires au CHU de Bordeaux : description, enjeux, perspectives

Abstract : Since their arrival in 2011, immune checkpoint inhibitors (ICI) are revolutionizing cancer treatment. Stimulating the immune system may induce immune adverse events such as endocrine adverse events which are frequent. This observational, retrospective, monocentric study at Bordeaux University Hospital included patients treated with ICI regardless of cancer type, from July 2011 to May 2017. Main objective was to describe the prevalence of endocrine adverse events, especially dysthyroidism. Secondary objective was to characterize these dysthyroidism to offer adapted diagnostic and therapeutic support. 565 patients have been included, mean age was 63,4 +/- 13,5 years with 66,4% of men. 43 dysthyroidism (7.62%), 10 hypophysitis (1.77%) and 1 diabetes (0.18%) have been observed. Dysthyroidism prevalence in all-cancer patients treated with anti-PD-1 was 6-7%, 31% when a bitherapy combining anti-PD-1 and anti-CTLA-4 was used and 1,5% when anti-CTLA-4 monotherapy was used. Among the 43 dysthyroidism cases, an equal proportion of hypothyroidism, biphasic thyroiditis and thyrotoxicosis has been noticed. Mechanism seems to be variable according to dysthyroidism type : auto-immune or secondary to local inflammation. 97,6% of dysthyroidism were low grade (1-2). Symptoms were shown in 31% of cases. Hypothyroidism became permanent and supplemented by levothyroxine in 82,7% of cases with an average follow-up of 14,9 +/- 8,9 months despite stopping ICI of 67% of these patients. According to the latest news, levothyroxine dose was greater than or equal to 50 μg per day for 84% of treated patients.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02067758
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Submitted on : Thursday, March 14, 2019 - 12:54:53 PM
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Pauline Poupon. Toxicités endocriniennes des inhibiteurs de checkpoints immunitaires au CHU de Bordeaux : description, enjeux, perspectives. Médecine humaine et pathologie. 2018. ⟨dumas-02067758⟩

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