Login Register Cart 0
Generic placeholder image

Endocrine, Metabolic & Immune Disorders - Drug Targets

Editor-in-Chief

ISSN (Print): 1871-5303
ISSN (Online): 2212-3873

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Case Report

Hypophysitis Induced by Sintilimab in the Treatment of Bladder Cancer: A Case Report

Author(s): Ran Li, Baichuan Jiang, Yiran Zhu, Likuan Gao, Yaru Zhou and Shijie Yang*

Volume 24, Issue 5, 2024

Published on: 10 October, 2023

Page: [606 - 610] Pages: 5

DOI: 10.2174/0118715303257557231002064417

Price: $65

Abstract

Background: Immune checkpoint inhibitors (ICIs), as novel antitumor drugs, have been widely used in the clinic and have shown good antitumor effects. However, their widespread use has also led to the emergence of various immune-related adverse events (IrAEs). Hypophysitis is a rare but serious IrAE. Due to its complex and changeable clinical manifestations, hypophysitis may be easily overlooked, leading to delayed diagnosis and treatment.

Case Presentation: A 68-year-old male patient was diagnosed with bladder cancer (T2bNXM0) in October 2021. He received two cycles of immunotherapy with sintilimab and chemotherapy with gemcitabine and cisplatin (GC). One month after the second treatment, he gradually developed recurrent fever, anorexia, drowsiness, and delirium. Laboratory examination revealed hyponatremia, decreased adrenocorticotropic hormone, and hypocortisolemia. The pituitary MRI showed no abnormality. The patient was diagnosed with immunotherapy-induced hypophysitis (IH) caused by sintilimab, leading to downstream endocrine disorders. With hormone replacement therapy, he was in a good mood, had a good appetite, and made an overall recovery.

Conclusion: Immunotherapy-induced hypophysitis (IH) can result in a severe adrenal crisis, and prompt recognition and diagnosis are crucial. Clinicians must remain vigilant for the possibility of IH in patients who exhibit recurrent fever, anorexia, cognitive decline, and personality changes following ICI treatment. It is imperative to consider this diagnosis early to initiate appropriate management promptly.

« Previous
[1]
Naimi, A.; Mohammed, R.N.; Raji, A.; Chupradit, S.; Yumashev, A.V.; Suksatan, W.; Shalaby, M.N.; Thangavelu, L.; Kamrava, S.; Shomali, N.; Sohrabi, A.D.; Adili, A.; Noroozi-Aghideh, A.; Razeghian, E. Tumor immunotherapies by immune checkpoint inhibitors (ICIs); the pros and cons. Cell Commun. Signal., 2022, 20(1), 44.
[http://dx.doi.org/10.1186/s12964-022-00854-y] [PMID: 35392976]
[2]
Johnson, D.B.; Nebhan, C.A.; Moslehi, J.J.; Balko, J.M. Immune-checkpoint inhibitors: Long-term implications of toxicity. Nat. Rev. Clin. Oncol., 2022, 19(4), 254-267.
[http://dx.doi.org/10.1038/s41571-022-00600-w] [PMID: 35082367]
[3]
Di Dalmazi, G.; Ippolito, S.; Lupi, I.; Caturegli, P. Hypophysitis induced by immune checkpoint inhibitors: A 10-year assessment. Expert Rev. Endocrinol. Metab., 2019, 14(6), 381-398.
[http://dx.doi.org/10.1080/17446651.2019.1701434] [PMID: 31842671]
[4]
Zhang, L.; Mai, W.; Jiang, W.; Geng, Q. Sintilimab: A promising anti-tumor pd-1 antibody. Front. Oncol., 2020, 10, 594558.
[http://dx.doi.org/10.3389/fonc.2020.594558] [PMID: 33324564]
[5]
Yi, M.; Zheng, X.; Niu, M.; Zhu, S.; Ge, H.; Wu, K. Combination strategies with PD-1/PD-L1 blockade: current advances and future directions. Mol. Cancer, 2022, 21(1), 28.
[http://dx.doi.org/10.1186/s12943-021-01489-2] [PMID: 35062949]
[6]
Lou, B.; Wei, H.; Yang, F.; Wang, S.; Yang, B.; Zheng, Y.; Zhu, J.; Yan, S. Preclinical characterization of GLS-010 (Zimberelimab), a novel fully human Anti-PD-1 therapeutic monoclonal antibody for cancer. Front. Oncol., 2021, 11, 736955.
[http://dx.doi.org/10.3389/fonc.2021.736955] [PMID: 34604074]
[7]
Dolladille, C.; Ederhy, S.; Sassier, M.; Cautela, J.; Thuny, F.; Cohen, A.A.; Fedrizzi, S.; Chrétien, B.; Da-Silva, A.; Plane, A.F.; Legallois, D.; Milliez, P.U.; Lelong-Boulouard, V.; Alexandre, J. Immune checkpoint inhibitor rechallenge after immune-related adverse events in patients with cancer. JAMA Oncol., 2020, 6(6), 865-871.
[http://dx.doi.org/10.1001/jamaoncol.2020.0726] [PMID: 32297899]
[8]
Lemiale, V.; Meert, A.P.; Vincent, F.; Darmon, M.; Bauer, P.R.; Van de Louw, A.; Azoulay, E. Severe toxicity from checkpoint protein inhibitors: What intensive care physicians need to know? Ann. Intensive Care, 2019, 9(1), 25.
[http://dx.doi.org/10.1186/s13613-019-0487-x] [PMID: 30707321]
[9]
Iglesias, P.; Peiró, I.; Biagetti, B.; Paja-Fano, M.; Cobo, D.A.; García Gómez, C.; Mateu-Salat, M.; Genua, I.; Majem, M.; Riudavets, M.; Gavira, J.; Lamas, C.; Fernández Pombo, A.; Guerrero-Pérez, F.; Villabona, C.; Cabezas Agrícola, J.M.; Webb, S.M.; Díez, J.J. Immunotherapy-induced isolated ACTH deficiency in cancer therapy. Endocr. Relat. Cancer, 2021, 28(12), 783-792.
[http://dx.doi.org/10.1530/ERC-21-0228] [PMID: 34609950]
[10]
Bando, H.; Kanie, K.; Takahashi, Y. Paraneoplastic autoimmune hypophysitis: An emerging concept. Best Pract. Res. Clin. Endocrinol. Metab., 2022, 36(3), 101601.
[http://dx.doi.org/10.1016/j.beem.2021.101601] [PMID: 34876362]
[11]
National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE) https://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc. htm
[12]
de Filette, J.; Andreescu, C.; Cools, F.; Bravenboer, B.; Velkeniers, B. A systematic review and meta-analysis of endocrine-related adverse events associated with immune checkpoint inhibitors. Horm. Metab. Res., 2019, 51(3), 145-156.
[http://dx.doi.org/10.1055/a-0843-3366] [PMID: 30861560]
[13]
Sznol, M.; Postow, M.A.; Davies, M.J.; Pavlick, A.C.; Plimack, E.R.; Shaheen, M.; Veloski, C.; Robert, C. Endocrine-related adverse events associated with immune checkpoint blockade and expert insights on their management. Cancer Treat. Rev., 2017, 58, 70-76.
[http://dx.doi.org/10.1016/j.ctrv.2017.06.002] [PMID: 28689073]
[14]
Esteves-Ferreira, S.; Rosinha, P. Immune checkpoint inhibitor-induced hypophysitis: Clinical and biochemical features. J. Cancer Res. Clin. Oncol., 2023, 149(10), 7925-7932.
[http://dx.doi.org/10.1007/s00432-023-04659-5] [PMID: 36869230]
[15]
Ariyasu, R.; Horiike, A.; Yoshizawa, T.; Dotsu, Y.; Koyama, J.; Saiki, M.; Sonoda, T.; Nishikawa, S.; Kitazono, S.; Yanagitani, N.; Nishio, M. Adrenal insufficiency related to anti-programmed death-1 therapy. Anticancer Res., 2017, 37(8), 4229-4232.
[http://dx.doi.org/10.21873/anticanres.11814] [PMID: 28739711]
[16]
Nguyen, H.; Shah, K.; Waguespack, S.G.; Hu, M.I.; Habra, M.A.; Cabanillas, M.E.; Busaidy, N.L.; Bassett, R.; Zhou, S.; Iyer, P.C.; Simmons, G.; Kaya, D.; Pitteloud, M.; Subudhi, S.K.; Diab, A.; Dadu, R. Immune checkpoint inhibitor related hypophysitis: Diagnostic criteria and recovery patterns. Endocr. Relat. Cancer, 2021, 28(7), 419-431.
[http://dx.doi.org/10.1530/ERC-20-0513] [PMID: 33890870]
[17]
Haanen, J.; Obeid, M.; Spain, L.; Carbonnel, F.; Wang, Y.; Robert, C.; Lyon, A.R.; Wick, W.; Kostine, M.; Peters, S.; Jordan, K.; Larkin, J. Management of toxicities from immunotherapy: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann. Oncol., 2022, 33(12), 1217-1238.
[http://dx.doi.org/10.1016/j.annonc.2022.10.001] [PMID: 36270461]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy