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Published on: September 25, 2018
Hypophysitis induced by anti-programmed cell death protein 1 immunotherapy in non-small cell lung cancer: Three case
Yun Zheng1,2, Chen-Yu Zhu1,2, Jing Lin2
1Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310030, Zhejiang Province, China.
Background:
Hypophysitis induced by programmed cell death 1 protein (PD-1) immune checkpoint inhibitors is rare and poorly described. We report three patients with non-small cell lung cancer who developed hypophysitis after anti-PD-1 immunotherapy.
Case Summary:
Both case 1 and case 2 presented with common symptoms of fatigue, nausea, and vomiting. However, case 3 showed rare acute severe symptoms such as hoarse voice, bucking, and difficulty in breathing even when sitting. Following two cycles of immunotherapy in case 3, the above severe symptoms and pituitary gland enlargement were found on magnetic resonance imaging at the onset of hypophysitis. These symptoms were relieved after 10 d of steroid treatment. Case 3 was the first patient with these specific symptoms, which provided a new insight into the diagnosis of hypophysitis. In addition, we found that the clinical prognosis of patients with hypophysitis was related to the dose of steroid therapy. Case 3 was treated with high-dose hormone therapy and her pituitary-corticotropic axis dysfunction returned to normal after more than 6 mo of steroid treatment. Cases 1 and 2 were treated with the low-dose hormone, and dysfunction of the pituitary-corticotropic axis was still present after up to 7 mo of steroid treatment.
Conclusion:
The clinical symptoms described in this study provide a valuable reference for the diagnosis and treatment of immune-related hypophysitis.
Insights
Programmed cell death 1 protein (PD-1) inhibitors can cause hypophysitis in non-small cell lung cancer patients. High-dose steroids improved outcomes in a severe case, suggesting dose-dependent prognosis.
Area of Science:
- Oncology
- Endocrinology
- Immunology
Background:
- Hypophysitis is a rare side effect of programmed cell death 1 protein (PD-1) immune checkpoint inhibitors.
- This study investigates three non-small cell lung cancer patients who developed hypophysitis following anti-PD-1 immunotherapy.
Observation:
- Two patients presented with fatigue, nausea, and vomiting.
- A third patient experienced severe acute symptoms including hoarse voice, bucking, and dyspnea, alongside pituitary enlargement on MRI.
- These severe symptoms resolved with steroid treatment.
Findings:
- The severe presentation in Case 3 offered new diagnostic insights for hypophysitis.
- High-dose steroid therapy led to normalization of the pituitary-corticotropic axis in Case 3 after six months.
- Low-dose steroid therapy in Cases 1 and 2 did not fully restore pituitary-corticotropic axis function after seven months.
Implications:
- The reported clinical symptoms serve as a diagnostic reference for immune-related hypophysitis.
- Steroid dosage appears to influence the clinical prognosis of hypophysitis following PD-1 inhibitor therapy.
- Understanding these associations can guide treatment strategies for patients receiving immunotherapy.
