Gaps in the management of adrenal insufficiency in melanoma survivors: a retrospective cohort studyResearch in context
Summary: Background: Due to limited data on managing immunotherapy-induced secondary adrenal insufficiency (SAI) in melanoma survivors, this study investigated its management strategies and outcomes. Methods: This retrospective cohort study analyzed melanoma patients treated with immune checkpoint...
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Elsevier
2025-01-01
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| author | Wei Lin Wei Wang F. Stephen Hodi Le Min |
| author_facet | Wei Lin Wei Wang F. Stephen Hodi Le Min |
| author_sort | Wei Lin |
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| description | Summary: Background: Due to limited data on managing immunotherapy-induced secondary adrenal insufficiency (SAI) in melanoma survivors, this study investigated its management strategies and outcomes. Methods: This retrospective cohort study analyzed melanoma patients treated with immune checkpoint inhibitors (ICIs) with SAI (Mel_SAI, n = 161), without SAI (Mel_CON, n = 168), and patients with pituitary adenoma-related SAI (Pit_SAI, n = 106) at our institution from January 2013 to November 2023. We compared glucocorticoid management patterns, quality of life using distress scores, and the impact of different glucocorticoid types on survival outcomes using Kaplan–Meier analysis. Findings: Mel_SAI received significantly higher initial (median: 30 mg; IQR: 20–30 mg) and maintenance (median: 25 mg; IQR: 20–30 mg) hydrocortisone doses than Pit_SAI (initial: 20 mg; IQR: 15–30 mg; maintenance: 15 mg; IQR: 15–23 mg). Over half of Mel_SAI received prednisone as initial glucocorticoid replacement (n = 89, 55%), compared to 27% (n = 29) of Pit_SAI. Distress scores were significantly higher in Mel_SAI (median: 3; IQR: 2–5) than in Pit_SAI (median: 2; IQR: 1–3), but similar between Mel_CON. Prednisone use was associated with decreased survival in Mel_SAI (hazard ratio: 2.31; 95% CI: 1.14–4.46). Interpretation: Higher glucocorticoid doses and prednisone use in melanoma patients with SAI may be due to higher distress scores rather than SAI itself. Given the negative impact on survival and potential side effects, we recommend hydrocortisone at standard doses as the preferred glucocorticoid replacement in melanoma patients with SAI. Funding: None. |
| format | Article |
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| institution | Kabale University |
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| language | English |
| publishDate | 2025-01-01 |
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| spelling | doaj-art-bad72353fb3a480c9628cf1647af58e52025-01-22T05:43:17ZengElsevierEClinicalMedicine2589-53702025-01-0179102984Gaps in the management of adrenal insufficiency in melanoma survivors: a retrospective cohort studyResearch in contextWei Lin0Wei Wang1F. Stephen Hodi2Le Min3Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Endocrinology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, FuZhou, Fujian, PR ChinaDivision of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USADepartment of Medical Oncology Dana-Farber Cancer Institute and Parker Institute for Cancer Immunotherapy, 450 Brookline Avenue, Boston, MA, 02215, USADivision of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Corresponding author. Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Avenue, Boston, MA, 02115, USA.Summary: Background: Due to limited data on managing immunotherapy-induced secondary adrenal insufficiency (SAI) in melanoma survivors, this study investigated its management strategies and outcomes. Methods: This retrospective cohort study analyzed melanoma patients treated with immune checkpoint inhibitors (ICIs) with SAI (Mel_SAI, n = 161), without SAI (Mel_CON, n = 168), and patients with pituitary adenoma-related SAI (Pit_SAI, n = 106) at our institution from January 2013 to November 2023. We compared glucocorticoid management patterns, quality of life using distress scores, and the impact of different glucocorticoid types on survival outcomes using Kaplan–Meier analysis. Findings: Mel_SAI received significantly higher initial (median: 30 mg; IQR: 20–30 mg) and maintenance (median: 25 mg; IQR: 20–30 mg) hydrocortisone doses than Pit_SAI (initial: 20 mg; IQR: 15–30 mg; maintenance: 15 mg; IQR: 15–23 mg). Over half of Mel_SAI received prednisone as initial glucocorticoid replacement (n = 89, 55%), compared to 27% (n = 29) of Pit_SAI. Distress scores were significantly higher in Mel_SAI (median: 3; IQR: 2–5) than in Pit_SAI (median: 2; IQR: 1–3), but similar between Mel_CON. Prednisone use was associated with decreased survival in Mel_SAI (hazard ratio: 2.31; 95% CI: 1.14–4.46). Interpretation: Higher glucocorticoid doses and prednisone use in melanoma patients with SAI may be due to higher distress scores rather than SAI itself. Given the negative impact on survival and potential side effects, we recommend hydrocortisone at standard doses as the preferred glucocorticoid replacement in melanoma patients with SAI. Funding: None.http://www.sciencedirect.com/science/article/pii/S2589537024005637Secondary adrenal insufficiencyCancer immunotherapyGlucocorticoid replacementMelanomaPatient distress |
| spellingShingle | Wei Lin Wei Wang F. Stephen Hodi Le Min Gaps in the management of adrenal insufficiency in melanoma survivors: a retrospective cohort studyResearch in context EClinicalMedicine Secondary adrenal insufficiency Cancer immunotherapy Glucocorticoid replacement Melanoma Patient distress |
| title | Gaps in the management of adrenal insufficiency in melanoma survivors: a retrospective cohort studyResearch in context |
| title_full | Gaps in the management of adrenal insufficiency in melanoma survivors: a retrospective cohort studyResearch in context |
| title_fullStr | Gaps in the management of adrenal insufficiency in melanoma survivors: a retrospective cohort studyResearch in context |
| title_full_unstemmed | Gaps in the management of adrenal insufficiency in melanoma survivors: a retrospective cohort studyResearch in context |
| title_short | Gaps in the management of adrenal insufficiency in melanoma survivors: a retrospective cohort studyResearch in context |
| title_sort | gaps in the management of adrenal insufficiency in melanoma survivors a retrospective cohort studyresearch in context |
| topic | Secondary adrenal insufficiency Cancer immunotherapy Glucocorticoid replacement Melanoma Patient distress |
| url | http://www.sciencedirect.com/science/article/pii/S2589537024005637 |
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