A case of pituitary crisis caused by cadonilimab treatment of advanced gastric cancer

Published on Feb. 01, 2024Total Views: 795 times Total Downloads: 496 times Download Mobile

Affiliation: Department of Pharmacy, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Keywords: Cadonilimab Pituitary crisis Immune-related adverse event Adverse drug reaction

DOI: 10.12173/j.issn.1005-0698.202312065

Reference: XU Qian, XU Ting.A case of pituitary crisis caused by cadonilimab treatment of advanced gastric cancer[J].Yaowu Liuxingbingxue Zazhi,2024, 33(1):116-120.DOI: 10.12173/j.issn.1005-0698.202312065.[Article in Chinese]  Copied

Abstract
Full-text
References

Abstract

A 75-year-old female patient with gastric cancer received cadonilimab (500 mg, iv, d1) combined with albumin-bound paclitaxel (300 mg, iv, d2) and tegafur, gimeracil and oteracil potassium (40 mg, po, bid, d2-15) and 21 days was a cycle. Admission examination at the end of 4 cycles of treatment, laboratory tests showed adrenocorticotropic hormone <1.00 pg·mL^-1, cortisol 0.42 μg·dL^-1 and serum sodium 131 mmol·L^-1. Immune checkpoint inhibitor-related hypophysitis was diagnosed, and pituitary crisis was developed on the 4th day. The diagnosis of hypophysitis concurrent with pituitary crisis was considered to be related to cadonilimab. High-dose glucocorticoids replacement and symptomatic treatment such as rehydration to maintain electrolyte imbalance were given. On the 9th day after admission, the patient was basically in remission. The administration of cadonilimab may cause pituitary crisis, which is relatively rare in clinical practice. This case reminds that the possibility of hypophysitis when patients emerge with the symptom of fatigue and anorexia along with hyponatremia. Assessment of endocrine gland function, correct diagnosis and proper therapy are of significant clinical value to improve the patients' prognosis.

Full-text

Please download the PDF version to read the full text: download

References

1.Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions[J]. Clin Pharmacol Ther, 1981, 30(2): 239-245. DOI: 10.1038/clpt.1981.154.

2.Puzanov I, Diab A, Abdallah K, et al. Managing toxicities associated with immune checkpoint inhibitors: consensus recommendations from the Society for Immunotherapy of Cancer (SITC) Toxicity Management Working Group[J]. J Immunother Cancer, 2017, 5(1): 95. DOI: 10.1186/s40425-017-0300-z.

3.中国临床肿瘤学会指南工作委员会. 中国临床肿瘤学会(CSCO)胃癌诊疗指南2022[M]. 北京: 人民卫生出版社. 2022: 16

4.Pang X, Huang Z, Zhong T, et al. Cadonilimab, a tetravalent PD-1/CTLA-4 bispecific antibody with trans-binding and enhanced target binding avidity[J]. MAbs, 2023, 15(1): 2180794. DOI: 10.1080/19420862.2023.2180794.

5.Wei SC, Levine JH, Cogdill AP, et al. Distinct cellular mechanisms underlie anti-ctla-4 and anti-PD-1 checkpoint blockade[J]. Cell, 2017, 170(6): 1120-1133.e17. DOI: 10.1016/j.cell.2017.07.024.

6.Baumeister SH, Freeman GJ, Dranoff G, et al. Coinhibitory pathways in immunotherapy for cancer[J]. Annu Rev Immunol, 2016, 34: 539-573. DOI: 10.1146/annurev-immunol-032414-112049.

7.Wright JJ, Powers AC, Johnson DB. Endocrine toxicities of immune checkpoint inhibitors[J]. Nat Rev Endocrinol, 2021, 17(7): 389-399. DOI: 10.1038/s41574-021-00484-3.

8.Martins F, Sofiya L, Sykiotis GP, et al. Adverse effects of immune-checkpoint inhibitors: epidemiology, management and surveillance[J]. Nat Rev Clin Oncol, 2019, 16(9): 563-580. DOI: 10.1038/s41571-019-0218-0.

9.Kobayashi T, Iwama S, Sugiyama D, et al. Anti-pituitary antibodies and susceptible human leukocyte antigen alleles as predictive biomarkers for pituitary dysfunction induced by immune checkpoint inhibitors[J]. J Immunother Cancer, 2021, 9(5): e002493.DOI: 10.1136/jitc-2021-002493.

10.Mihic-Probst D, Reinehr M, Dettwiler S, et al. The role of macrophages type 2 and T-regs in immune checkpoint inhibitor related adverse events[J]. Immunobiology, 2020, 225(5): 152009. DOI: 10.1016/j.imbio.2020.152009.

11.de Filette J, Andreescu CE, Cools F, et al. A systematic review and meta-analysis of endocrine-related adverse events associated with immune checkpoint inhibitors[J]. Horm Metab Res, 2019, 51(3): 145-156. DOI: 10.1055/a-0843-3366.

12.Iwama S, Kobayashi T, Arima H. Clinical characteristics, management, and potential biomarkers of endocrine dysfunction induced by immune checkpoint inhibitors[J]. Endocrinol Metab (Seoul), 2021, 36(2): 312-321. DOI: 10.3803/EnM.2021.1007.

13.Barroso-Sousa R, Barry WT, Garrido-Castro AC, et al. Incidence of endocrine dysfunction following the use of different immune checkpoint inhibitor regimens: a systematic review and meta-analysis[J]. JAMA Oncol. 2018. 4(2): 173-182. DOI: 10.1001/jamaoncol.2017.3064.

14.Torino F, Barnabei A, De Vecchis L, et al. Hypophysitis induced by monoclonal antibodies to cytotoxic T lymphocyte antigen 4: challenges from a new cause of a rare disease[J]. Oncologist, 2012, 17(4): 525-535. DOI: 10.1634/theoncologist.2011-0404.

15.武常玲, 马佩, 束永前, 等. PD-1单抗治疗晚期实体瘤致垂体炎的诊治[J]. 临床肿瘤学杂志, 2022, 27(11): 1025-1028. [Wu CL, Ma P, Su YQ, et al. Diagnosis and treatment of hypophysitis caused by PD-1 inhibitors in patients with advanced solid tumors[J]. Chinese Clinical Oncology, 2022, 27(11): 1025-1028.] DOI: 10.3969/j.issn.1009-0460.2022.11.011.

16.Keam SJ. Cadonilimab: first approval[J]. Drugs, 2022, 82(12): 1333-1339. DOI: 10.1007/s40265-022-01761-9.

17.中华医学会内分泌学分会免疫内分泌学组. 免疫检查点抑制剂引起的内分泌系统免疫相关不良反应专家共识(2020)[J]. 中华内分泌代谢杂志, 2021, 37(1): 1-16. DOI: 10.3760/cma.j.cn311282-20200627-00475.

18.Haanen J, Obeid M, Spain L, et al. Management of toxicities from immunotherapy: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up[J]. Ann Oncol, 2022, 33(12): 1217-1238. DOI: 10.1016/j.annonc.2022.10.001.