According to a new study published in the journal Clinical Cancer Research, researchers at Brigham and Women's Hospital in Boston, Massachusetts have found that supportive treatment, rather than systemic high-dose corticosteroid treatment, may be best in patients with melanoma who develop ipilimumab-related hypophysitis, or inflammation of the pituitary gland.
For the study, the researchers identified 187 patients with metastatic melanoma who were treated with melanoma from the Dana-Farber Cancer Institute oncology database. Of those, 25 developed ipilimumab-related hypophysitis. They found that ipilimumab-related hypophysitis was more common in males than females (16.1% vs 8.7%).
In addition, they found that the median time to onset was 9 weeks following initiation of ipilimumab therapy. Patients who developed hypophysitis received either systemic high-dose corticosteroid treatment or supportive treatment.
Of those with hypophysitis, hyponatremia was resolved in 92%, pituitary enlargement was resolved in 73%, secondary hypothyroidism was resolved in 64%, and male secondary hypogonadism was resolved in 45%. Resolution of secondary adrenal insufficiency occurred in no patients.
Results showed that treatment with systemic high-dose corticosteroids did not improve outcomes of ipilimumab-related hypophysitis, and one-year overall survival was similar in patients who received corticosteroids (83%) and in patients who received supportive treatment.
The authors aimed to examine the onset and outcome of ipilimumab-related hypophysitis and the response to treatment with systemic high dose corticosteroids. Systemic high dose corticosteroid therapy in patients with ipilimumab-related hypophysitis may not be indicated. Instead, supportive treatment of hypophysitis-related hormone deficiencies with the corresponding hormone replacement should be given.