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Programmed Death 1 Inhibitor-Induced Hypothyroidism on the Palliative Care Unit: Case Report

Kelvin Lou1, Shalini Nayar1

  • 1Department of Medicine, University of British Columbia, Kelowna, British Columbia, Canada.

Journal of Palliative Care
|July 10, 2019
PubMed

Insights

Novel cancer therapies like PD-1 inhibitors can cause side effects. This case highlights pembrolizumab-induced hypothyroidism leading to fatigue and hypoglycemia, posing end-of-life diagnostic challenges.

Area of Science:

  • Oncology
  • Immunotherapy
  • Endocrinology

Background:

  • Emergence of novel immune-based cancer therapies, including programmed death 1 (PD-1) inhibitors, for curative and palliative care.
  • PD-1 inhibitors represent a significant advancement in cancer treatment.
  • Growing body of post-market data on PD-1 inhibitors is revealing a spectrum of associated side effects.

Observation:

  • Post-market surveillance of PD-1 inhibitors has identified a broad range of adverse events.
  • Some side effects are particularly relevant to symptom management and pose diagnostic difficulties in end-of-life care.
  • A specific case involving a patient treated with pembrolizumab is presented.

Findings:

  • The patient developed hypothyroidism as a direct result of pembrolizumab treatment.
  • This drug-induced hypothyroidism manifested as extreme fatigue.
  • Persistent hypoglycemia was also observed as a consequence of the treatment.

Implications:

  • Pembrolizumab-induced hypothyroidism can present significant challenges in symptom control for cancer patients.
  • Accurate diagnosis of treatment-related side effects is crucial, especially in palliative and end-of-life settings.
  • This case underscores the importance of monitoring endocrine function during PD-1 inhibitor therapy.
Keywords:
fatiguehypothyroidmelanomapalliativepembrolizumabprogrammed death 1 (PD-1) inhibitor

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