Imaging for assessment of cancer treatment response to immune checkpoint inhibitors can be complementary in identifying hypophysitis
- Author(s)
- Galligan, A; Iravani, A; Lasocki, A; Wallace, R; Weppler, AM; Sachithanandan, N; Chiang, C; Colman, PG; Wentworth, J; Spain, L; Au-Yeung, G; Lee, B; Kay, TWH; Hicks, RJ; Sandhu, S; Krishnamurthy, B;
- 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
- Publisher's Version
- https://doi.org/10.3389/fendo.2023.1295865
- 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