Treatment of Ipilimumab Induced Graves' Disease in a Patient with Metastatic Melanoma.
TLDR
A case of Graves' disease diagnosed after initiation of ipilimumab in a patient with melanoma and total thyroidectomy and left neck dissection is reported as a definitive treatment for both hyperthyroidism and residual melanoma.Abstract:
Objective. Thyroid disease has been reported among the endocrinopathies that can occur after treatment with ipilimumab. Graves' disease, however, has been rarely reported with this medication. Here we report a case of Graves' disease diagnosed after initiation of ipilimumab in a patient with melanoma. Methods. We present the clinical presentation and management course of this patient followed by a related literature review. Results. A 67-year-old male with metastatic melanoma was started on ipilimumab. He developed hyperthyroidism after two doses of ipilimumab. The cause of hyperthyroidism was determined to be Graves' disease. Ipilimumab was held and the patient was started on methimazole with return to euthyroid status. Ipilimumab was resumed and the patient continued methimazole during the course of ipilimumab therapy, with controlled hyperthyroidism. Restaging studies following four cycles of ipilimumab showed complete response in the lungs, with residual melanoma in the neck. The patient then underwent total thyroidectomy and left neck dissection as a definitive treatment for both hyperthyroidism and residual melanoma. Conclusion. Graves' disease can develop after starting ipilimumab and methimazole can be an effective treatment. For patients whose hyperthyroidism is well-controlled on methimazole, ipilimumab may be resumed with close monitoring.read more
Citations
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Incidence of Endocrine Dysfunction Following the Use of Different Immune Checkpoint Inhibitor Regimens: A Systematic Review and Meta-analysis
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TL;DR: The mainstay of management of ICPi-related endocrinopathies is hormone replacement and symptom control, but others, such as central adrenal insufficiency and primary hypothyroidism, appear to be persistent in most cases.
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A Systematic Review and Meta-Analysis of Endocrine-Related Adverse Events Associated with Immune Checkpoint Inhibitors.
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Immune-Related Thyroiditis with Immune Checkpoint Inhibitors.
Priyanka C. Iyer,Maria E. Cabanillas,Steven G. Waguespack,Mimi I. Hu,Sonali Thosani,Victor R. Lavis,Naifa L. Busaidy,Sumit K. Subudhi,Adi Diab,Ramona Dadu +9 more
TL;DR: IrT manifests as an early onset of thyrotoxicosis, which is largely asymptomatic, followed by rapid transition to hypothyroidism requiring long-term levothyroxine substitution, and the evolution of irT is more rapid with combination ICI.
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Spectrum of immune checkpoint inhibitors-induced endocrinopathies in cancer patients: a scoping review of case reports
Meng H. Tan,Ravi Iyengar,Ravi Iyengar,Kara Mizokami-Stout,Sarah Yentz,Mark MacEachern,Li Yan Shen,Bruce G. Redman,Roma Y. Gianchandani +8 more
TL;DR: There was variability of information in the case reports but all met the study criteria to make a diagnosis and clinical reasoning integrating clinical, biochemical and treatment information is needed to properly diagnose and manage ICI-induced endocrinopathies.
References
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Improved Survival with Ipilimumab in Patients with Metastatic Melanoma.
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TL;DR: Ipilimumab, with or without a gp100 peptide vaccine, as compared with gp100 alone, improved overall survival in patients with previously treated metastatic melanoma.
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TL;DR: Evidence-based clinical guidelines for the management of thyrotoxicosis are described that would be useful to generalist and subspeciality physicians and others providing care for patients with this condition.
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Endocrine-related adverse events following ipilimumab in patients with advanced melanoma: a comprehensive retrospective review from a single institution
TL;DR: It is observed that CTLA4 blockade alone, and in particular in combination with PD1 blockade, is associated with an increased risk of symptomatic, sometimes severe, hypophysitis as well as thyroid dysfunction.
Journal ArticleDOI
Ipilimumab-induced hypophysitis: a detailed longitudinal analysis in a large cohort of patients with metastatic melanoma.
Alexander T. Faje,Ryan J. Sullivan,Donald P. Lawrence,Nicholas A. Tritos,Riley Fadden,Anne Klibanski,Lisa B. Nachtigall +6 more
TL;DR: Diffuse pituitary enlargement was observed exclusively in all cases of IH and, upon retrospective review of magnetic resonance imaging scans, this finding preceded the clinical diagnosis of hypophysitis in eight patients.