Thyroid dysfunction induced by nivolumab: searching for disease patterns and outcomes.

Area of Science:

• Oncology
• Immunology
• Endocrinology

Background:

• Nivolumab, a programmed death-1 receptor inhibitor, activates T-cells against cancer.
• Thyroid dysfunction (TD) is a frequent immune-related adverse event (irAE) associated with nivolumab therapy.
• Understanding the characteristics and impact of nivolumab-induced TD is crucial for patient management.

Purpose of the Study:

• To determine the prevalence, patterns, and clinical outcomes of TD in cancer patients treated with nivolumab.
• To analyze the temporal relationship between nivolumab administration and the onset of TD.
• To investigate the association between nivolumab-induced TD and overall survival (OS) in different cancer types.

Main Methods:

• Retrospective analysis of cancer patients treated with nivolumab in 2016.
• Assessment of thyroid function tests, thyroid autoimmunity markers, and thyroid imaging.
• Correlation of TD incidence and type with clinical outcomes, including overall survival.

Main Results:

• Out of 73 patients, 17 (23.3%) developed TD. Thyrotoxicosis occurred in 7 patients, with a median TSH nadir at 51 days.
• Hypothyroidism developed in 10 patients, with a median TSH peak at 110 days. Transient thyroiditis followed by hypothyroidism was observed.
• In non-small cell lung cancer (NSCLC) patients, TD was associated with significantly better OS (HR=0.4, p=0.035).

Conclusions:

• Nivolumab-induced TD is a common and varied irAE, with thyrotoxicosis preceding hypothyroidism.
• A pattern of transient thyroiditis evolving into hypothyroidism is notable in a subset of patients.
• Nivolumab-induced TD may be a predictive biomarker for improved survival in NSCLC patients.