Ipilimumab-induced hypophysitis in advanced melanoma

The authors analyzed the occurrence, management and risk factors of hypophysitis (a complication of the immune system following ipilimumab [Yervoy] therapy) in advanced melanoma patients.  

In advanced melanoma (stage III/IV), cancer spreads rapidly from the skin to other parts of the body. This is known as metastasis. Immunotherapy is an effective treatment option used in advanced melanoma. It uses the body’s own immune system to attack the tumor cells and kill them. Ipilimumab is an approved immunotherapy for melanoma. It works by inhibiting important proteins in the immune system. The side effects associated with ipilimumab are known as immune-related adverse events (IRAEs). Hypophysitis is one of these IRAEs. It results in the inflammation of the pituitary gland (an important gland attached to the base of the brain).

Not much is known about ipilimumab-induced hypophysitis (IH). Further research is needed in this aspect to develop useful strategies for the management of IH. 

The aim of this study was to examine the occurrence of IH, treatment outcomes in IH and identify risk factors associated with IH.

154 patients with metastatic melanoma were evaluated in this study. All patients received ipilimumab according to standard dosing. The median (mid-point) follow-up time was 11.5 months following treatment with ipilimumab.

IH was diagnosed in 11% of patients. The occurrence of IH in males was 15.6% compared to 3.6% in females. The average age of patients with IH was 68.2 years. The average age of patients without IH was 59.9 years.

All patients with IH had anterior hypopituitarism. This meant that these patients had reduced hormone secretion from the front side (anterior) of the pituitary gland. For 76% of these patients, hypopituitarism was a persistent side effect. Enlargement of the pituitary gland was observed in all IH patients. However, 8 patients experienced pituitary gland enlargement before IH.Median survival in patients with IH was 19.4 months. This was compared to 8.8 months in patients who did not have IH. 

The authors concluded that male gender and older age were risk factors for IH. They also indicated that the occurrence of hypophysitis could positively predict survival in melanoma patients treated with ipilimumab.