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Thyroid Dysfunction in Patients Receiving Immunotherapy for Advanced Kidney Cancer

By: Meg Barbor, MPH
Posted: Friday, August 11, 2017

In patients with renal cell carcinoma receiving checkpoint inhibitor therapy, thyroid dysfunction is common, but in a cohort evaluated by Juan Carlos Osorio, MD, of Memorial Sloan Kettering Cancer Center, and colleagues, the onset of thyroid dysfunction was early, thyroiditis was always transient, and no new cases were detected beyond 10 months. Their research was published in the Journal of Clinical Oncology.

Checkpoint inhibitors are rapidly gaining relevance in the management of metastatic renal cell carcinoma, and treatment is generally well tolerated. However, immune-mediated thyroid dysfunction is reported in up to 10% of patients in clinical trials. The investigators assessed thyroid function tests at baseline and during therapy in 59 patients with renal cell carcinoma treated with checkpoint inhibitor therapy at Memorial Sloan Kettering.

Of the patients evaluated, 20 were hypothyroid, and 39 were euthyroid at baseline. The median time to onset of thyroid dysfunction was 1.4 months, and 13 of 39 euthyroid patients developed dysfunction and required thyroid replacement. In 6 of those 13 patients, transient thyroiditis preceded hypothyroidism but did not require treatment. All patients with hypothyroidism required replacement therapy, but none required discontinuation of immunotherapy.

“Confirming these findings in larger cohorts will provide meaningful data to guide the management of thyroid dysfunction when using this new class of agents outside of clinical trials,” the investigators concluded.