Ipilimumab-Associated Hypophysitis Not Improved by High-Dose Corticosteroids

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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.

Ipilimumab-Associated Hypophysitis Not Improved by High-Dose Corticosteroids
Supportive treatment, rather than systemic corticosteroid treatment, may be best in melanoma with ipilimumab-related hypophysitis.
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.

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