In a nutshell
This study developed guidelines for the early detection and treatment of hypophysitis (HP; inflammation of the pituitary gland), a side effect of treatment with ipilimumab. Researchers suggested that these guidelines are necessary to ensure early detection and treatment of this condition to prevent associated mortality.
Some background
Ipilimumab is an antibody that helps the immune system fight tumor cells. It is a common treatment for metastatic (spread to other parts of the body) melanoma. However, ipilimumab can cause potentially life-threatening side effects associated with the immune system. Prior studies reported the incidence of these side effects in 61-77% of patients treated with ipilimumab. HP incidence can be between 0-17%. Because the pituitary gland is responsible for the production of many hormones, patients with this condition can have a decreased level of hormones. It is important for HP to be diagnosed early.
Methods & findings
The objective of this study was to create guidelines for the early detection and treatment of HP induced by ipilimumab treatment.
This study included 10 patients with advanced melanoma treated with standard therapy with ipilimumab. The majority of patients experienced symptoms after 9 weeks of ipilimumab treatment. Fatigue and nausea were the most common first symptoms. Headache was noticed by 6 patients. Pituitary MRI (method to visualize the interior of the body) was normal in half of the patients. All symptoms were controlled by hormone replacement therapy.
Based on the review of the 10 patients, this study presented guidelines for screening and treatment of HP. It was recommended that blood levels be tested in the laboratory at the beginning of the ipilimumab treatment and at the start of every cycle.
High-dose glucocorticoids (such as prednisone) were advised only in the presence of visual complications. Lower-dose glucocorticoids were recommended otherwise.
It was suggested that treatment with hormone replacement be delayed until it is known that there is no cortisol (a type of hormone) deficiency.
Follow-up should be continued for at least 4 months after the start of ipilimumab treatment. The follow-up should be more frequent in the case of patients treated before with other immune system inhibitors or PD-1 therapy (such as nivolumab).
The bottom line
This study recommended guidelines for the early detection and treatment of HP in patients with advanced melanoma treated with ipilimumab.
Published By :
Internal medicine journal
Date :
May 26, 2015
