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Cited by 37Cancer Immunotherapy and BiomarkersPituitary Gland Disorders and TreatmentsAdrenal Hormones and Disorders

Ipilimumab‐induced hypophysitis in melanoma patients: an A ustralian case series

Lam, T., Chan, M. M. K., Sweeting, A. N., De Sousa, S. M. C., Clements, A., Carlino, M. S., Long, G. V., Tonks, K. +3 more·2015·Internal Medicine Journal
DOI 10.1111/imj.12819
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Abstract

BACKGROUND: Ipilimumab (Yervoy; Bristol-Myers Squibb) is a novel fully humanised monoclonal antibody that blocks cytotoxic T-lymphocyte antigen 4, an immune checkpoint molecule, to augment anti-tumour T-cell responses. It is associated with significant immune-related side-effects including hypophysitis. AIM: We reviewed the clinical and biochemical characteristics of 10 patients with ipilimumab-induced hypophysitis (IH), and developed guidelines for the early detection and management of IH based on our experiences at three major teaching hospitals in Sydney. METHODS: All patients were evaluated at the Crown Princess Mary Cancer Centre and Department of Endocrinology, Westmead Hospital, Department of Endocrinology, Royal Prince Alfred Hospital, the Melanoma Institute Australia and Macarthur Cancer Therapy Centre, Campbelltown Hospital from 2010 to 2014. Relevant data were extracted by review of medical records. Main outcome measures included clinical features, hormone profile and radiological findings associated with IH, and presence of pituitary recovery. RESULTS: Ten patients were identified with IH. In four patients who underwent monitoring of plasma cortisol, there was a fall in levels in the weeks prior to presentation. The pituitary-adrenal and pituitary-thyroid axes were affected in the majority of patients, with the need for physiological hormone replacement. Imaging abnormalities were identified in five of 10 patients, and resolved without high-dose glucocorticoid therapy. To date, all patients remain on levothyroxine and hydrocortisone replacement, where appropriate. CONCLUSIONS: There is significant morbidity associated with development of IH. We suggest guidelines to assist with early recognition and therapeutic intervention.

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Crossref · 10.1111/imj.12819

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  • Anti-CTLA4 antibody treatments may result in occurrence of hypophysitis in up to 10% of treated patients, with central hypothyroidism being the most frequently reported deficiency in the early phase.

    “This is of significant clinical importance as the recently developed anti-CTLA4 (cytotoxic T lymphocyte protein 4) antibody treatments may result in the occurrence of hypophysitis in up to 10% of treated patients (Lam et al., 2015) with central hypothyroidism being the most frequently reported deficiency in the early phase (Faje, 2015).”

    From The hypothalamus-pituitary-thyroid (HPT)-axis and its role in physiology and pathophysiology of other hypothalamus-pituitary functions (2021) · cites this paper as Lam et al., 2015

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Authors
Lam, T., Chan, M. M. K., Sweeting, A. N., De Sousa, S. M. C., Clements, A., Carlino, M. S., Long, G. V., Tonks, K., Chua, E., Kefford, R. F., & Chipps, D. R.
Affiliations
  • Westmead Hospital (AU)
  • The University of Sydney (AU)
  • Department of Endocrinology St Vincent's Hospital Sydney New South Wales Australia
  • Garvan Institute of Medical Research (AU)
Corresponding author
Lam, T.
ORCID
Venue
Internal Medicine Journal
Publisher
Wiley
Published
2015-10
Volume
45
Issue
10
Pages
1066-1073
ISSN
  • 1444-0903 (ISSN-L)
  • 1445-5994
DOI
10.1111/imj.12819
OpenAlex
W1767743048
Cited by
37
References
21
Citations by year
2026: 1 · 2025: 1 · 2024: 3 · 2023: 2 · 2022: 3 · 2021: 6 · 2020: 3 · 2019: 5 · 2018: 4 · 2017: 3 · 2016: 4 · 2015: 2
FWCI
1.89
Type
journal article
Language
en
Update notices
correction (2015-12-09)
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Internal Medicine Journal (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Keywords
ipilimumab, hypophysitis, melanoma, immune checkpoint inhibitors, immune-related adverse events, CTLA-4 blockade, pituitary dysfunction, cortisol, hormone replacement therapy, levothyroxine, pituitary imaging, glucocorticoid therapy
MeSH terms
Ipilimumab, Aged, Antibodies, Monoclonal, Australia, Female, Humans, Hypopituitarism, Immunotherapy, Magnetic Resonance Imaging, Male, Melanoma, Middle Aged, Skin Neoplasms, Hormone Replacement Therapy, CTLA-4 Antigen, Antibodies, Monoclonal, Humanized

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