BASELINE TSH LEVEL IS ASSOCIATED WITH RISK OF ANTI-PD-1-INDUCED THYROID DYSFUNCTION.

Area of Science:

• Oncology
• Immunology
• Endocrinology

Background:

• Metastatic melanoma patients treated with immune checkpoint inhibitors, specifically anti-programmed cell death 1 (PD-1) agents, can develop immune-related adverse events (irAEs).
• Thyroid dysfunction is a recognized irAE, but its incidence and risk factors in this patient population require further characterization.

Purpose of the Study:

• To characterize anti-PD-1-induced thyroid irAEs in metastatic melanoma patients.
• To identify risk factors associated with the development of thyroid irAEs.

Main Methods:

• Retrospective review of 154 metastatic melanoma patients treated with PD-1 inhibitors.
• Analysis of thyroid irAEs occurring within 120 days of treatment initiation.
• Examination of associations with age, gender, melanoma characteristics, treatment protocol, and baseline thyroid-stimulating hormone (TSH).

Main Results:

• 42.4% of patients developed thyroid dysfunction, including subclinical, overt hypothyroidism, and overt hyperthyroidism.
• Higher baseline TSH levels were observed in patients who developed overt hypothyroidism compared to hyperthyroidism or euthyroid states (P = .05).
• A pretreatment TSH >2.19 mIU/mL was associated with an increased risk of overt thyroid dysfunction (OR, 3.46; 95% CI, 1.2 to 9.8).

Conclusions:

• Thyroid dysfunction is a frequent complication of PD-1 inhibitor therapy in metastatic melanoma.
• Elevated baseline TSH is a significant risk factor for developing overt thyroid dysfunction.
• Patients with higher baseline TSH may benefit from closer thyroid function monitoring during anti-PD-1 treatment.