The clinical reports on adrenal insufficiency of patients with advanced solid tumors accepting anti?PD?1 antibody, SHR?1210 therapy
10.3760／cma.j.issn.0253?3766.2019.06.013
- VernacularTitle:程序性死亡蛋白 1 抗体 SHR-1210 治疗晚期实体瘤患者中肾上腺皮质功能减退的临床报道
- Author:
Jialin TANG
1
;
Jing HUANG
;
Xi WANG
;
Xuelian CHEN
;
Qun LI
;
Hongnan MO
;
Dawei WU
;
Bo LAN
;
Binghe XU
Author Information
1. 国家癌症中心 国家肿瘤临床医学研究中心 中国医学科学院北京协和医学院肿瘤医院肿瘤内科100021
- Keywords:
Solid tumors;
SHR?1210;
Anti?PD?1 antibody;
Secondary adrenal insufficiency;
Hypophysitis
- From:
Chinese Journal of Oncology
2019;41(6):466-470
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the adrenocortical function changes of patients with advanced solid tumors who received the anti?programmed cell death protein?1 ( PD?1) antibody, SHR?1210 therapy. Methods The clinical data of 98 patients with advanced solid tumors who were enrolled in a prospective phase I trial of SHR?1210 therapy at our institution between April 27, 2016 and June 8, 2017 were collected. The levels of plasma adrenocorticotropic hormone ( ACTH) and cortisol were evaluated in 96 patients. The clinical manifestations, laboratory tests and radiologic data were collected to define the immune?related adrenal insufficiency. Results Until December 14th, 2018, no SHR?1210 related primary adrenal insufficiency occurred, and the incidence of immune?related secondary adrenal insufficiency was 1.0% among the 96 patients, which was identified as grade 2. No patient developed grade 3?4 adrenal insufficiency. The main clinical manifestations of the patient who was diagnosed as secondary adrenal insufficiency were grade 2 fatigue, anorexia and headache.The patient developed fatigue and anorexia at the 267th day after receiving the first dose of SHR?1210, the hypocortisolism occurred on the 279th day, and the headache emerged on the 291th day. The anorexia of patient who treated by physiological replacement doses of glucocorticoid since the 457th day was attenuated.The patient whose cortisol level was still below the normal limit continued to accept the hormone replacement therapy up to 776 days after the initial administration of SHR?1210. Conclusions The incidence of SHR?1210 related adrenal insufficiency of patients with advanced solid tumors is low, and the symptoms can be effectively ameliorated by hormone replacement therapy. The potential adverse outcome of adrenal insufficiency following immunotherapy should be noticed by clinicians to avoid the occurrence of adrenal crisis.
