Abstract
Purpose
Immune checkpoint inhibitors (ICIs) are of great success in cancer therapy. This study aimed to identify adrenal insufficiency (AI) associated with immune checkpoint inhibitor (ICI) treatment in cancer patients receiving steroid replacement therapy and report the clinical characteristics of ICI-associated AI and concurrent immune-associated adverse events (irAEs).
Methods
Patients prescribed cortisone acetate between January 2020 and March 2022 were reviewed to identify AI associated with ICI treatment. Data collected included indication of ICI (cancer type), drug characteristics, and outcomes.
Results
A total of 101 patients were diagnosed with AI following treatment with ICIs. The median age was 64 years (range 22-83 years); 73.3% of the patients were male. Median time to develop primary AI and secondary AI after starting ICI therapy was 200.5 (35-280) days and 178 (16-562) days, respectively. Concurrent irAEs occurred in 67 (66.3%) patients and included 63 (62.4%) endocrine irAEs. Log-rank test showed that there was a trend toward higher likelihood of death at 120-day follow-up in patients initially receiving intravenous hydrocortisone compared with those receiving oral cortisone acetate after diagnosis of AI (p = 0.029).
Conclusion
This retrospective study comprehensively documented the clinical characterization of ICI-associated AI. Those initially receiving intravenous hydrocortisone after diagnosis of AI were associated with higher likelihood of death. Physicians should be aware of the variability of ICI-associated irAEs early in the treatment, early diagnoses, and timely management should be made.
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Data availability
Data are available upon reasonable request.
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Funding
This study was funded by the Shanghai Key Clinical Specialist Construction Projects (shslczdzk06504) and the Shanghai “Rising Stars of Medical Talent” Youth Development Program-Youth Medical Talents-Clinical Pharmacist Program under Grant (SHWJRS(2021)_099).
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QC, LZ, XL, and QL. contributed to conception and design. QC, WW, QX, LZ, and XL. were responsible for provision of study material or patients. QC, WW, and LZ. were involved in collection and/or assembly of data, and data analysis and interpretation. QC, LZ, and QL. wrote the manuscript. QC, WW, XL, QX, LZ, and QL. approved the final manuscript.
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Our research protocol was approved by the Ethics Committee of Zhongshan Hospital, Fudan University.
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Cai, Q., Wu, W., Li, X. et al. Immune checkpoint inhibitor-associated adrenal insufficiency in Chinese cancer patients: a retrospective analysis. J Cancer Res Clin Oncol 149, 14113–14123 (2023). https://doi.org/10.1007/s00432-023-05093-3
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DOI: https://doi.org/10.1007/s00432-023-05093-3