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Thyroid dysfunction induced by immune checkpoint inhibitors and tumor progression during neoadjuvant therapy of non‑small cell lung cancer: A case report and literature review.

ABSTRACT: Immune checkpoint inhibitors (ICIs) have a demonstrable treatment response in patients with resectable non-small cell lung cancer (NSCLC). However, immune-related adverse events and tumor progression in patients administered ICIs are of great concern. The present case study is of a 59-year-old male with NSCLC (squamous, stage IIIA) who received neoadjuvant immunotherapy combined with chemotherapy before surgery. The patient first developed hyperthyroidism and then hypothyroidism, indicating that ICI-related thyroid dysfunction had occurred. Furthermore, the patient suffered from tumor progression and could not undergo resection. The present case called attention to the prevention and management of irAEs, and the precaution that should be taken with regard to tumor progression. The case also suggested that the development of ICI-related thyroid dysfunction may not predict an improved response to ICI therapies, which needs further evidence to illustrate.

SUBMITTER: Li X

PROVIDER: S-EPMC10580010 | biostudies-literature | 2023 Nov

REPOSITORIES: biostudies-literature

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Thyroid dysfunction induced by immune checkpoint inhibitors and tumor progression during neoadjuvant therapy of non‑small cell lung cancer: A case report and literature review.

Li Xinyi X Wang Xun X Wang Shaodong S Liu Yanguo Y Wang Ruilin R Liu Yi Y Huang Lin L Feng Yufei Y Xie Xiaohui X Shi Luwen L

Oncology letters 20230929 5

Immune checkpoint inhibitors (ICIs) have a demonstrable treatment response in patients with resectable non-small cell lung cancer (NSCLC). However, immune-related adverse events and tumor progression in patients administered ICIs are of great concern. The present case study is of a 59-year-old male with NSCLC (squamous, stage IIIA) who received neoadjuvant immunotherapy combined with chemotherapy before surgery. The patient first developed hyperthyroidism and then hypothyroidism, indicating that ...[more]

PMID: 37854868

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Project description:BackgroundWith the extensive utilization of immune checkpoint inhibitors (ICIs) across various cancers, ICIs-related thyroid dysfunction (ICI-TD) has become a growing concern in clinical practice. This study aimed to devise an individualized management strategy for ICI-TD to enhance the early identification and proactive management in cancer patients.MethodsWe designed and conducted a three-phase study. Initially, we analyzed the influencing factors through a systematic review and meta-analysis, which adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Moreover, the study protocol was registered with PROSPERO (CRD42019131133). Subsequently, prediction models for ICI-TD were developed utilizing 11 algorithms based on the real-world cohort data from July 20, 2018 (the approval date of the first ICIs, Pembrolizumab in China), to October 31, 2022. Considering discrimination, calibration, and clinical utility, we selected the model with the best performance for web calculator development. Finally, individualized management strategies for ICI-TD were proposed by combining evidence-based analysis with practical considerations.ResultsThe systematic review encompassed 21 observational studies involving 4,145 patients, revealing associations between ICI-TD and factors such as female gender, age, receipt of Pembrolizumab (versus other ICIs), and baseline levels of thyroid-stimulating hormone, free thyroxine, and antithyroid antibodies. In the prediction model development phase, 621 participants were enrolled, with 36 patients developing ICI-TD. The model based on the LightGBM algorithm demonstrated superior performance, leading to the development of a web calculator. Based on these findings and existing guidelines, individualized monitoring and treatment pathways for pharmacists were devised.ConclusionThis study offers comprehensive insights into managing ICI-TD, potentially enhancing tailored cancer immunotherapy management.

Dataset Information

Thyroid dysfunction induced by immune checkpoint inhibitors and tumor progression during neoadjuvant therapy of non‑small cell lung cancer: A case report and literature review.

Publications

Thyroid dysfunction induced by immune checkpoint inhibitors and tumor progression during neoadjuvant therapy of non‑small cell lung cancer: A case report and literature review.

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