Thyroiditis in Patients Receiving Immune Checkpoint Blockade Therapies Characterized Interview with:

Le Min, MD,PhD Brigham and Women's Hospital, Endocrinology Division

Dr. Le Min

Le Min, MD,PhD
Brigham and Women’s Hospital, Endocrinology Division What is the background for this study?

Dr. Min: As you know, immune checkpoint blockade therapies by anti-CTLA4 and Anti-PD1 have shown promising and durable anti-cancer effects on several advanced malignancies. Interestingly, endocrine disorders are among the most common adverse effects associated with immune checkpoint blockade therapies. More interestingly, it appears that hypophysitis, the inflammation of the pituitary is commonly related to anti-CTLA4 therapy while thyroid disorders are more commonly seen in anti-PD1 monotherapy and the combined therapy with anti-PD1 and anti-CTLA4.

Anti-CTLA4-related hypophysitis has been well characterized but there is no study to characterize the thyroid disorders associated with anti-PD1 monotherapy and the combined therapy with anti-PD1 and anti-CTLA4. As an endocrinologist, I have been taking care of a population of such patients who received either monotherapy with anti-PD1 or combined therapy with anti-PD1 and anti-CTLA4 and developed thyroid disorders. What are the main findings?

Dr. Min: In our study, we characterized the initial manifestation of thyroid disorders, the time to onset of thyroid disorders and the dynamic evolution of the thyroid disorders in patients receiving monotherapy or combined therapy. We found that thyrotoxicosis is the most common initial manifestation in patients receiving combined therapy. On the other hand, there were about 50% of patients receiving monotherapy manifested as hypothyroidism.

In combined therapy, most of the thyroid disorders occurred shortly after first treatment while only about 20% of the thyroid disorder occurred after first treatment in monotherapy. Overall, most thyroid disorders occurred within 12 weeks in both groups. We also found that there is no difference in the transition time from thyrotoxicosis to hypothyroidism in both groups. What should clinicians and patients take away from your report?

Dr. Min: Our findings support that thyroid disorder induced by immune checkpoint blockade is thyroiditis which can manifest as either hypothyroidism or thyrotoxicosis followed by hypothyroidism.

We recommend the clinicians to monitor thyroid function closely. Check baseline thyroid function and then before each infusion. After 4th infusion, may check less often.

In terms of management, a beta-blocker with or without a course of high dose corticosteroids during thyrotoxicosis phase and levothyroxine replacement when patients develop hypothyroidism. Thank you for your contribution to the community.


ENDO 2016 abstract:

Characterizing Thyroid Disorders in Patients Receiving PD1 Blockade or Combined PD1 and CTLA4 Blockade Therapy

Poster Board SAT 251

Hyunju Lee1, Kevin Zhang1, Rona S. Carroll2, Ursula B. Kaiser3 and Le Min*4
1Brigham and Women’s Hospital, Boston, MA, 2Brigham and Women’s Hospital/Harvard Med School, Boston, MA, 3Brigham and Women’s Hospital/Harvard Medical School, Boston, MA, 4Harvard Medical school, Brigham and Women’s Hospital, Boston, MA

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Le Min, MD,PhD (2016). Thyroiditis in Patients Receiving Immune Checkpoint Blockade Therapies Characterized

Last Updated on April 1, 2016 by Marie Benz MD FAAD