Can baseline endocrinological examination and thyroid ultrasound predict the development of thyroid disease in immunotherapy-treated patients? Results from a prospective, single-center, open-label study

Stefano Gay, Giovanni Rossi, Giuliana Corica, Giulia Graziani, Carlo Genova, Erika Rijavec, Marco Tagliamento, Francesco Grossi, Massimo Giusti

Research output: Contribution to journalArticle

Abstract

Purpose: Immune-checkpoint inhibitors have shown great efficacy in clinical oncology and a very safe toxicity profile. Nevertheless, endocrine toxicity and, in particular, thyroid diseases are among the most frequently reported adverse events. The aim of this study was to assess the utility of a complete endocrine evaluation before starting therapy, in order to predict which patients will develop a thyroid disease and will need a close follow-up. Methods: Twenty-eight patients were treated with ipilimumab and nivolumab for non-small-cell lung cancer or malignant pleural mesothelioma. All patients underwent complete endocrine evaluation, including blood examination and thyroid ultrasound, before immunotherapy was started. Blood hormonal tests were repeated every 2 weeks and another visit was scheduled after three courses of therapy. Results: On baseline evaluation, a previously unknown thyroid alteration was found in 14 patients (50%). During follow-up, seven patients (25%) developed an overt thyroid disease, mainly destructive thyroiditis. A significant association was found between the development of this dysfunction and both thyroid ultrasound hypoechogenicity (RR = 5.00, P = 0.027) and thyroid volume (P = 0.0063) at the baseline. A clinical score, which also included the thyroperoxidase antibody titer and concomitant therapies, proved highly predictive of the development of disease (spec. 95%, sens. 100%; P < 0.0001). Conclusions: It is advisable to carry out a complete endocrinological assessment before starting immunotherapy, in order to improve patient management. We obtained encouraging data regarding the possibility of predicting a thyroid disease and undertaking personalized follow-up. However, these need to be confirmed and expanded by subsequent larger studies.

Original languageEnglish
JournalEndocrine
DOIs
Publication statusPublished - Jan 1 2019

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Thyroid Diseases
Immunotherapy
Thyroid Gland
Thyroiditis
Medical Oncology
Hematologic Tests
Non-Small Cell Lung Carcinoma
Therapeutics
Antibodies

Keywords

  • Endocrine side effects
  • Immune-related adverse events (IRAE)
  • Immunotherapy
  • Predictive factors
  • Thyroid disease
  • Thyroid ultrasound

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Can baseline endocrinological examination and thyroid ultrasound predict the development of thyroid disease in immunotherapy-treated patients? Results from a prospective, single-center, open-label study. / Gay, Stefano; Rossi, Giovanni; Corica, Giuliana; Graziani, Giulia; Genova, Carlo; Rijavec, Erika; Tagliamento, Marco; Grossi, Francesco; Giusti, Massimo.

In: Endocrine, 01.01.2019.

Research output: Contribution to journalArticle

Gay, Stefano ; Rossi, Giovanni ; Corica, Giuliana ; Graziani, Giulia ; Genova, Carlo ; Rijavec, Erika ; Tagliamento, Marco ; Grossi, Francesco ; Giusti, Massimo. / Can baseline endocrinological examination and thyroid ultrasound predict the development of thyroid disease in immunotherapy-treated patients? Results from a prospective, single-center, open-label study. In: Endocrine. 2019.
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AU - Corica, Giuliana

AU - Graziani, Giulia

AU - Genova, Carlo

AU - Rijavec, Erika

AU - Tagliamento, Marco

AU - Grossi, Francesco

AU - Giusti, Massimo

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