Imaging for assessment of cancer treatment response to immune checkpoint inhibitors can be complementary in identifying hypophysitis
Journal Title
Frontiers in Endocrinology
Publication Type
Research article
Abstract
INTRODUCTION: Hypophysitis is reported in 8.5%-14% of patients receiving combination immune checkpoint inhibition (cICI) but can be a diagnostic challenge. This study aimed to assess the role of routine diagnostic imaging performed during therapeutic monitoring of combination anti-CTLA-4/anti-PD-1 treatment in the identification of hypophysitis and the relationship of imaging findings to clinical diagnostic criteria. METHODS: This retrospective cohort study identified patients treated with cICI between January 2016 and January 2019 at a quaternary melanoma service. Medical records were reviewed to identify patients with a documented diagnosis of hypophysitis based on clinical criteria. Available structural brain imaging with magnetic resonance imaging (MRI) or computed tomography (CT) of the brain and 2-deoxy-2-[(18)F]fluoro-D-glucose positron emission tomography with computed tomography (FDG-PET/CT) were assessed retrospectively. The main radiological outcome measures were a relative change in pituitary size or FDG uptake temporally attributed to cICI. RESULTS: There were 162 patients (median age 60 years, 30% female) included. A total of 100 and 134 had serial CT/MRI of the brain and FDG-PET/CT, respectively. There were 31 patients who had a documented diagnosis of hypophysitis and an additional 20 who had isolated pituitary imaging findings. The pituitary gland enlargement was mild, and the largest absolute gland size was 13 mm, with a relative increase of 7 mm from baseline. There were no cases of optic chiasm compression. Pituitary enlargement and increased FDG uptake were universally transient. High-dose glucocorticoid treatment for concurrent irAEs prevented assessment of the pituitary-adrenal axis in 90% of patients with isolated imaging findings. CONCLUSION: Careful review of changes in pituitary characteristics on imaging performed for assessment of therapeutic response to iICI may lead to increased identification and more prompt management of cICI-induced hypophysitis.
Keywords
Humans; Female; Middle Aged; Male; Immune Checkpoint Inhibitors/therapeutic use; Retrospective Studies; Positron Emission Tomography Computed Tomography/methods; Fluorodeoxyglucose F18; *Hypophysitis/diagnostic imaging/drug therapy; *Pituitary Diseases; *Neoplasms; cancer imaging; combination immune checkpoint inhibition; hypophysitis; immune related adverse events; immunotherapy; pituitary gland
Department(s)
Cancer Imaging; Medical Oncology; Internal Medicine
PubMed ID
38093958
Open Access at Publisher's Site
https://doi.org/10.3389/fendo.2023.1295865
Terms of Use/Rights Notice
Refer to copyright notice on published article.


Creation Date: 2024-08-20 06:08:15
Last Modified: 2024-08-20 06:56:56

© 2024 The Walter and Eliza Hall Institute of Medical Research. Access to this website is subject to our Privacy Policy and Terms of Use

An error has occurred. This application may no longer respond until reloaded. Reload 🗙