open access

Vol 15, No 5 (2019)
CASE REPORT
Published online: 2019-10-29
Get Citation

Differential diagnosis of autoimmune pituitary failure and pituitary macroadenoma during nivolumab therapy in an NSCLC patient — a case report

Aleksandra Grzywna, Robert Kieszko, Paweł Krawczyk, Katarzyna Kurek, Izabela Drogoń, Julita Poleszak, Justyna Błach, Kamila Wojas-Krawczyk, Janusz Milanowski
DOI: 10.5603/OCP.2019.0003
·
Oncol Clin Pract 2019;15(5):260-264.

open access

Vol 15, No 5 (2019)
CASE REPORT
Published online: 2019-10-29

Abstract

We report a case of patient with non-small-cell lung cancer with expression of PD-L1 molecule on 1% of cancer cells, who was treated with chemotherapy, radiotherapy, and, during disease progression, with nivolumab immunotherapy. In the course of immunotherapy our patient developed symptoms of multi-axis hypopituitarism. Pituitary macroadenoma was diagnosed. In differential diagnosis, autoimmune inflammation of the pituitary gland in the course of nivolumab therapy was considered. After pituitary failure symptoms resolved, the immunotherapy was continued, with two-year remission of the disease.

Abstract

We report a case of patient with non-small-cell lung cancer with expression of PD-L1 molecule on 1% of cancer cells, who was treated with chemotherapy, radiotherapy, and, during disease progression, with nivolumab immunotherapy. In the course of immunotherapy our patient developed symptoms of multi-axis hypopituitarism. Pituitary macroadenoma was diagnosed. In differential diagnosis, autoimmune inflammation of the pituitary gland in the course of nivolumab therapy was considered. After pituitary failure symptoms resolved, the immunotherapy was continued, with two-year remission of the disease.

Get Citation

Keywords

non-small-cell lung cancer; immunotherapy; nivolumab; hypopituitarism

About this article
Title

Differential diagnosis of autoimmune pituitary failure and pituitary macroadenoma during nivolumab therapy in an NSCLC patient — a case report

Journal

Oncology in Clinical Practice

Issue

Vol 15, No 5 (2019)

Pages

260-264

Published online

2019-10-29

DOI

10.5603/OCP.2019.0003

Bibliographic record

Oncol Clin Pract 2019;15(5):260-264.

Keywords

non-small-cell lung cancer
immunotherapy
nivolumab
hypopituitarism

Authors

Aleksandra Grzywna
Robert Kieszko
Paweł Krawczyk
Katarzyna Kurek
Izabela Drogoń
Julita Poleszak
Justyna Błach
Kamila Wojas-Krawczyk
Janusz Milanowski

References (19)
  1. Ribas A, Wolchok JD. Cancer immunotherapy using checkpoint blockade. Science. 2018; 359(6382): 1350–1355.
  2. Alsaab HO, Sau S, Alzhrani R, et al. PD-1 and PD-L1 Checkpoint Signaling Inhibition for Cancer Immunotherapy: Mechanism, Combinations, and Clinical Outcome. Front Pharmacol. 2017; 8: 561.
  3. Michot JM, Bigenwald C, Champiat S, et al. Immune-related adverse events with immune checkpoint blockade: a comprehensive review. Eur J Cancer. 2016; 54: 139–148.
  4. Massarelli E, Papadimitrakopoulou V, Welsh J, et al. Immunotherapy in lung cancer. Transl Lung Cancer Res. 2014; 3(1): 53–63.
  5. Sznol M, Postow MA, Davies MJ, et al. Endocrine-related adverse events associated with immune checkpoint blockade and expert insights on their management. Cancer Treat Rev. 2017; 58: 70–76.
  6. Postow MA, Callahan MK, Wolchok JD. Immune Checkpoint Blockade in Cancer Therapy. J Clin Oncol. 2015; 33(17): 1974–1982.
  7. Postow MA. Managing immune checkpoint-blocking antibody side effects. Am Soc Clin Oncol Educ Book. 2015: 76–83.
  8. Boutros C, Tarhini A, Routier E, et al. Safety profiles of anti-CTLA-4 and anti-PD-1 antibodies alone and in combination. Nat Rev Clin Oncol. 2016; 13(8): 473–486.
  9. Weber JS, Postow M, Lao CD, et al. Management of Adverse Events Following Treatment With Anti-Programmed Death-1 Agents. Oncologist. 2016; 21(10): 1230–1240.
  10. Callahan MK, Wolchok JD. At the bedside: CTLA-4- and PD-1-blocking antibodies in cancer immunotherapy. J Leukoc Biol. 2013; 94(1): 41–53.
  11. Larkin J, Chiarion-Sileni V, Gonzalez R, et al. Combined Nivolumab and Ipilimumab or Monotherapy in Untreated Melanoma. N Engl J Med. 2015; 373(1): 23–34.
  12. Hodi FS, Chesney J, Pavlick AC, et al. Combined nivolumab and ipilimumab versus ipilimumab alone in patients with advanced melanoma: 2-year overall survival outcomes in a multicentre, randomised, controlled, phase 2 trial. Lancet Oncol. 2016; 17(11): 1558–1568.
  13. Faje AT, Sullivan R, Lawrence D, et al. Ipilimumab-induced hypophysitis: a detailed longitudinal analysis in a large cohort of patients with metastatic melanoma. J Clin Endocrinol Metab. 2014; 99(11): 4078–4085.
  14. Gulsin GS, Jacobs ML, Gohil S, et al. Competing interests in a lung cancer with metastasis to the pituitary gland: syndrome of inappropriate ADH secretion versus diabetes insipidus. Oxf Med Case Reports. 2016; 2016(6): 125–129.
  15. Horn L, Spigel DR, Vokes EE, et al. Nivolumab Versus Docetaxel in Previously Treated Patients With Advanced Non-Small-Cell Lung Cancer: Two-Year Outcomes From Two Randomized, Open-Label, Phase III Trials (CheckMate 017 and CheckMate 057). J Clin Oncol. 2017; 35(35): 3924–3933.
  16. Kastrisiou M, Kostadima FL, Kefas A, et al. Nivolumab-induced hypothyroidism and selective pituitary insufficiency in a patient with lung adenocarcinoma: a case report and review of the literature. ESMO Open. 2017; 2(4): e000217.
  17. Kitajima K, Ashida K, Wada N, et al. Isolated ACTH deficiency probably induced by autoimmune-related mechanism evoked with nivolumab. Jpn J Clin Oncol. 2017; 47(5): 463–466.
  18. Okano Y, Satoh T, Horiguchi K, et al. Nivolumab-induced hypophysitis in a patient with advanced malignant melanoma. Endocr J. 2016; 63(10): 905–912.
  19. Mengoli MC, Bertolini F, Maur M, et al. ALK-positive adenocarcinoma of the lung expressing neuroendocrine markers and presenting as a "pituitary adenoma". Pathologica. 2017; 109(4): 408–411.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Wydawcą serwisu jest  "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl