Cancer Management and Research (Oct 2020)

Managing Ipilimumab-Induced Hypophysitis: Challenges and Current Therapeutic Strategies

  • Tsoli M,
  • Kaltsas G,
  • Angelousi A,
  • Alexandraki K,
  • Randeva H,
  • Kassi E

Journal volume & issue
Vol. Volume 12
pp. 9551 – 9561

Abstract

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Marina Tsoli,1 Gregory Kaltsas,1 Anna Angelousi,2 Krystallenia Alexandraki,1 Harpal Randeva,3 Eva Kassi1 1First Department of Propaedeutic and Internal Medicine, Laiko University Hospital, National and Kapodistrian University of Athens, Athens, Greece; 2First Department of Internal Medicine, Laiko University Hospital, National and Kapodistrian University of Athens, Athens, Greece; 3Warwick Medical School, University of Warwick, Coventry CV4 7AL, UKCorrespondence: Marina TsoliFirst Department of Propaedeutic and Internal Medicine, Laiko University Hospital, National and Kapodistrian University of Athens, Agiou Thoma 17, Athens 11527, GreeceTel +30 6972692962Fax +30 2132061794Email [email protected]: Over the past years, progress has been made in cancer immunotherapy following the development of immune checkpoint inhibitors (ICI) that have been proved effective in the management of many malignancies. Ipilimumab, a monoclonal antibody against cytotoxic T-lymphocyte antigen-4 (CTLA-4), has been approved for the treatment of advanced melanoma but has been associated with the development of several endocrine immune-related adverse events (irAEs). Hypophysitis is the most common endocrine irAE related to ipilimumab with a reported incidence ranging from 1.8% to 17%. The mechanism underlying ipilimumab-induced hypophysitis implicates immune, inflammatory and genetic factors, but there are still some points that are not well understood and remain to be elucidated. The diagnosis is based mainly on clinical, biochemical and imaging data. The majority of patients display multiple hormone deficiencies that may recover or persist for a prolonged period of time with corticotroph deficiency usually being permanent. Immune-related hypopituitarism is treated with replacement of deficient hormones while in severe forms of hypophysitis treatment with high-dose glucocorticoids may be required. Proper evaluation and registration of patients in clinical trials and further investigation are needed to precisely clarify the pathophysiology of the ICI-related hypophysitis, define predictive factors and ameliorate the management and outcome of the disease.Keywords: immune checkpoint inhibitors, hypopituitarism, immune-related adverse effects

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