Thyroid toxicities of Immune checkpoint inhibitors, Experience from Emirate of Dubai, UAE


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Mohamed Omara, Muhammad Latif, Elamin Abdelgader, Fatheya Alawadi, Faraz Khan, Maroun Elkhoury, Dalia Elshourbagy, Dina Hamza, S Hammad Tirmazy

Abstract

Background

Immune checkpoint inhibitors (ICIs) including anti Programmed cell death receptor-1, programmed cell death ligand-1 and anti-Cytotoxic T-lymphocyte-antigen 4 have improved patients’ outcome in advanced malignancy. These agents are associated with immune related adverse events including skin toxicity, GI toxicity, hepatotoxicity, renal toxicities and endocrinopathies. The incidence of thyroid dysfunction including autoimmune thyroiditis, hypothyroidism and hyperthyroidism following the use of ICIs varies from 4% to 20%. Aim of this study is to evaluate thyroid toxicities of immune ICIs in our population.

Method

We reviewed electronic medical records of patients treated with ICIs for advanced malignancy from two tertiary care centers in the emirate of Dubai, UAE including Dubai hospital and American hospital from November 2015 to October 2019. Patients were identified through hospital cancer registry. Data regarding patients’ demographics, cancer type, type of ICIs, thyroid related adverse events, and duration of treatment were collected retrospectively.

Results

43 patients were identified with median age of 60 (27-80) years. 26 patients were male and 17 were female. Lung cancer was the most common diagnosis (n=24) followed by renal cell cancer (n=6), melanoma (n=4) and other malignancies (n=9). Majority of patients received Nivolumab (n=19, 44%) followed by Pembrolizumab (n=18, 42%), Atezolizumab (n=4, 9%) and Durvalumab (n=2, 5%) respectively. 

Pre-treatment thyroid functions were normal for all patients. After treatment initiation, 19 (44%) patients developed thyroid abnormalities including overt hypothyroidism (n=11, 57%), overt hyperthyroidism (n=2, 11%), subclinical hypothyroidism (n=4, 21%) and subclinical hyperthyroidism (n=2, 11%). 37 % patients treated with Nivolumab developed thyroid dysfunction as compared to Pembrolizumab (56%). Immune mediated thyroid toxicities were managed according to standard guidelines and there were no treatment discontinuations.

Conclusion

Hypothyroidism was the most common thyroid adverse event in patients treated with ICIs in our study. Treatment was well tolerated and there were no treatment related discontinuations or deaths.

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