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Thyroid dysfunction in Chinese nasopharyngeal carcinoma after anti-PD-1 therapy and its association with treatment
Zi-Hang Chen1,2, Wei-Hong Zheng1, Chen-Fei Wu1
1Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.
Background:
Programmed cell death protein-1 (PD-1) blockade therapies have demonstrated efficacy in nasopharyngeal carcinoma (NPC). Thyroid dysfunction is among the most common immune-related adverse events. This study aimed to explore the clinical pattern of thyroid dysfunction and its relationship with survival marker in nonmetastatic NPC after immunotherapy.
Methods:
From January 1, 2019, to December 31, 2021, 165 pairs of nonmetastatic NPC patients (165 with and 165 without anti-PD-1 immunotherapy) matched by the propensity score matching method were included in this study. Thyroid function was assessed retrospectively before the first treatment and during each immunotherapy cycle.
Results:
The spectrum of thyroid dysfunction was different between the immunotherapy and control groups (P < 0.001). Compared with the control group, patients in the immunotherapy group developed more hypothyroidism (14.545% vs. 7.273%), less hyperthyroidism (10.909% vs. 23.636%), and a distinct pattern, biphasic thyroid dysfunction (3.030% vs. 0%). Immunotherapy also accelerates the onset of hypothyroidism, which was earlier with a median onset time difference of 32 days (P < 0.001). Patients who acquired thyroid dysfunction during immunotherapy had better complete biological response to treatment (OR, 10.980; P = 0.042).
Conclusions:
For nonmetastatic NPC, thyroid dysfunction was associated with better response to treatment in immunotherapy but not in routine treatment. Thyroid function could be used as a predictor for survival and should be under regular and intensive surveillance in clinical practice of anti-PD-1 immunotherapy for nonmetastatic NPC.
Insights
Thyroid dysfunction is common with anti-PD-1 immunotherapy in nasopharyngeal carcinoma (NPC). Patients developing thyroid issues showed a better treatment response, suggesting thyroid function monitoring is crucial for survival prediction in NPC patients receiving immunotherapy.
Area of Science:
- Oncology
- Immunotherapy
- Endocrinology
Background:
- Programmed cell death protein-1 (PD-1) blockade shows efficacy in nasopharyngeal carcinoma (NPC).
- Thyroid dysfunction is a frequent immune-related adverse event.
- This study investigates thyroid dysfunction patterns and survival markers in nonmetastatic NPC patients undergoing immunotherapy.
Purpose of the Study:
- To explore the clinical pattern of thyroid dysfunction in nonmetastatic NPC patients receiving anti-PD-1 immunotherapy.
- To determine the relationship between thyroid dysfunction and survival markers in this patient group.
- To assess the impact of immunotherapy on thyroid function onset and spectrum.
Main Methods:
- Retrospective analysis of 165 pairs of nonmetastatic NPC patients (immunotherapy vs. control) from 2019-2021.
- Propensity score matching was used for patient selection.
- Thyroid function was assessed before treatment and throughout immunotherapy cycles.
Main Results:
- The spectrum of thyroid dysfunction differed significantly between immunotherapy and control groups (P < 0.001).
- Hypothyroidism was more prevalent (14.5% vs. 7.3%), while hyperthyroidism was less common (10.9% vs. 23.6%) in the immunotherapy group.
- Immunotherapy accelerated hypothyroidism onset (median 32 days earlier) and patients with thyroid dysfunction showed a better treatment response (OR, 10.980; P = 0.042).
Conclusions:
- Thyroid dysfunction is linked to a better treatment response in nonmetastatic NPC patients receiving immunotherapy, unlike routine treatment.
- Thyroid function can serve as a predictor for survival in this context.
- Regular and intensive thyroid function surveillance is recommended for patients undergoing anti-PD-1 immunotherapy for nonmetastatic NPC.
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