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Clinical characteristics of adrenal insufficiency as an immune-related adverse event in non-small-cell lung cancer

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Abstract

Adrenal insufficiency (AI) is an immune-related adverse event of immune checkpoint inhibitors and on occasion could be serious. There have been few reports of clinical information regarding AI associated with anti-programmed cell death protein-1 (anti-PD-1) antibody in non-small-cell lung cancer (NSCLC) patients. Patients with advanced NSCLC treated with anti-PD-1 antibodies between December 2015 and October 2017 were identified from the medical records of our institution. We investigated the frequency, symptoms, test results, and treatment outcomes of AI, and prognosis of patients who developed AI. In total, 282 NSCLC patients were treated with anti-PD-1 antibodies, and 4 patients (1.4%) were diagnosed as AI and 6 patients (2.1%) as suspicious of AI according to the laboratory data or clinical findings. The median follow-up period was 13.6 months. All patients with AI and suspicious of AI were treated with corticosteroid replacement, and performance status (PS) was improved in 50% of patients. Two of 10 patients were thought to have central AI. Six patients of 10 patients continued to receive anti-PD-1 antibodies with corticosteroid hormone replacement after diagnosis. The median progression-free survival and overall survival were 10.2 and 15.4 months, respectively. In conclusion, the incidence of AI among NSCLC patients treated with anti-PD-1 antibodies was similar to previous studies. Corticosteroid replacement improved PS, symptoms, and laboratory data of patients with AI and suspicious of AI. Corticosteroid replacement may contribute to continuation of anti-PD-1 antibodies and survival outcome was preferable in patients with AI and suspicious of AI receiving corticosteroid treatment.

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Authors and Affiliations

  1. Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Hanae Ida, Yasushi Goto, Jun Sato, Shintaro Kanda, Yuki Shinno, Ryou Morita, Shuji Murakami, Yuji Matsumoto, Tatsuya Yoshida, Hidehito Horinouchi, Yutaka Fujiwara, Noboru Yamamoto & Yuichiro Ohe

  2. Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

    Hanae Ida & Takahiro Fukuda

  3. Department of General Internal Medicine, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Ken Ohashi

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  1. Hanae Ida
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  2. Yasushi Goto
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  3. Jun Sato
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  15. Yuichiro Ohe
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Correspondence to Yasushi Goto.

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Conflict of interest

Yasushi Goto received honoraria from AstraZeneca, Pfizer; Shintaro Kanda received honoraria from AstraZeneca, Bristol-Myers Squibb, Ono Pharmaceutical and grants from AstraZeneca, Bristol-Myers Squibb, Ono Pharmaceutical; Hidehito Horinouchi received honoraria from AstraZeneca, Bristol-Myers Squibb, MSD, Ono Pharmaceutical and grants from Chugai Pharma, MSD, Ono Pharmaceutical, Taiho Pharmaceutical; Yutaka Fujiwara received honoraria from AstraZeneca, Bristol-Myers Squibb, Ono Pharmaceutical and grants from AstraZeneca, Bristol-Myers Squibb, Chugai Pharma, MSD; Noboru Yamamoto received honoraria from AstraZeneca, Bristol-Myers Squibb, Chugai Pharma, Eli Lilly, Ono Pharmaceutical, Pfizer and grants from Astellas, AvvVie, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Janssen Pharma, Kyowa-Hakko Kirin, MERCK, MSD, Novartis, Ono Pharmaceutical, Pfizer, Taiho Pharmaceutical, Takeda; Yuichiro Ohe received honoraria from AstraZeneca, Chugai Pharma, Ono Pharmaceutical and grants from AstraZeneca, Bristol-Myers Squibb, Chugai Pharma, MSD, Ono Pharmaceutical, Taiho Pharmaceutical. The other authors declare no conflict of interest for this article.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This retrospective study was approved by the Institutional Review Board of NCCH (2015–355).

Informed consent

Since this study was not utilizing human biological specimens, not involving invasiveness, and not involving intervention, formal consent was not required. The study was conducted in compliance with the “Ethical guidelines for medical and health research involving human subjects” [29].

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Ida, H., Goto, Y., Sato, J. et al. Clinical characteristics of adrenal insufficiency as an immune-related adverse event in non-small-cell lung cancer. Med Oncol 37, 30 (2020). https://doi.org/10.1007/s12032-020-01357-x

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