Managing Ipilimumab-Induced Hypophysitis: Challenges and Current Therapeutic Strategies

Over the past years, progress has been made in cancer immunotherapy following the development of immune checkpoint inhibitors (ICI) that have been proved effective in the management of many malignancies. Ipilimumab, a monoclonal antibody against cytotoxic T-lymphocyte antigen-4 (CTLA-4), has been ap...

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Published inCancer management and research Vol. 12; pp. 9551 - 9561
Main Authors Tsoli, Marina, Kaltsas, Gregory, Angelous, Anna, Alexandraki, Krystallenia, Randeva, Harpal, Kassi, Eva
Format Journal Article
LanguageEnglish
Published Macclesfield Dove Medical Press Limited 01.01.2020
Taylor & Francis Ltd
Dove
Dove Medical Press
Subjects
Antibodies
Antigens
Antineoplastic agents
Bevacizumab
Cancer therapies
Cancer treatment
Carboplatin
Competition
Complications and side effects
Cytotoxicity
Development and progression
Drug dosages
Epidemiology
hypopituitarism
immune checkpoint inhibitors
immune-related adverse effects
Immunotherapy
Melanoma
Monoclonal antibodies
Nivolumab
Pathophysiology
Pituitary gland
Prostate cancer
Review
Targeted cancer therapy
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Summary:Over the past years, progress has been made in cancer immunotherapy following the development of immune checkpoint inhibitors (ICI) that have been proved effective in the management of many malignancies. Ipilimumab, a monoclonal antibody against cytotoxic T-lymphocyte antigen-4 (CTLA-4), has been approved for the treatment of advanced melanoma but has been associated with the development of several endocrine immunerelated adverse events (irAEs). Hypophysitis is the most common endocrine irAE related to ipilimumab with a reported incidence ranging from 1.8% to 17%. The mechanism underlying ipilimumab-induced hypophysitis implicates immune, inflammatory and genetic factors, but there are still some points that are not well understood and remain to be elucidated. The diagnosis is based mainly on clinical, biochemical and imaging data. The majority of patients display multiple hormone deficiencies that may recover or persist for a prolonged period of time with corticotroph defciency usually being permanent. Immune-related hypopituitarism is treated with replacement of deficient hormones while in severe forms of hypophysitis treatment with high-dose glucocorticoids may be required. Proper evaluation and registration of patients in clinical trials and further investigation are needed to precisely clarify the pathophysiology of the ICI-related hypophysitis, define predictive factors and ameliorate the management and outcome of the disease. Keywords: immune checkpoint inhibitors, hypopituitarism, immune-related adverse effects
Bibliography:ObjectType-Article-2
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ISSN:1179-1322
1179-1322
DOI:10.2147/CMAR.S224791