Risk factors in association with adrenal insufficiency in hospitalized solid tumor patients on immunotherapy.

Abstract

e24183 Background: Immune checkpoint inhibitors (ICIs) have transformed cancer therapy and significantly improved clinical outcomes. However, their use has been associated with immune-related adverse events (irAEs). Among these, primary adrenal insufficiency is an uncommon but potentially life-threatening complication that carries a substantial risk of morbidity and mortality as it can lead to shock. The objective of the study was to identify risk factors associated with the development of immunotherapy related (IR) adrenal insufficiency. Methods: We conducted a retrospective chart review of solid-tumor patients admitted to the hospital medicine service for IR toxicities between 2021 and 2022, to identify cases of IR adrenal insufficiency. Patient demographics and baseline characteristics were analyzed by descriptive statistics. Logistic regression analysis was used to assess the association between baseline characteristics and the relative risk of developing IR adrenal insufficiency. Results: Over the study period, 144 patients required hospitalization for complications attributed to IR toxicities. Among these, 10 patients (7%) were found to have adrenal insufficiency. Patient demographics and baseline characteristics are shown in Table 1. After logistic regression univariate analysis, characteristics associated with the risk of developing IR adrenal insufficiency included: Use of Ipilimumab (OR:12.53 , CI 3.41–46.01 p = 0.001), Use of Nivolumab (OR : 7.30, CI 1.85 – 28.74 p = 0.004 ), Immunotherapy type Anti CTLA-4 with Anti PD-1 (OR: 7.84 CI 2.11– 29.17 p = 0.002 ) and Anti CTLA-4 alone (OR: 11.44 CI 2.12– 61.67 p = 0.005 ). A trend toward an association was observed for history of Stroke (OR: 3.9, CI 0.79-19.34 p = 0.096) and for cancer stage (OR: 0.57 CI 0.29-1.09, p = 0.089). Conclusions: ICI associated adrenal insufficiency was strongly associated with exposure to CTLA-4 based regimens, particularly Ipilimumab alone and in combination with Anti PD-1. These findings suggest a distinct high-risk population warranting heightened vigilance. Awareness of baseline and treatment-related risk factors may facilitate earlier diagnosis and mitigate morbidity and mortality associated with this IR endocrinopathy. Further studies are needed to corroborate these findings. CHARACTERISTIC OVERALL (N=10) GENDER, n (%)FemaleMale 4 (40%)6 (60%) RACE, n (%) Asian Black or African American Other White or Caucasian 1 (10.00%) 0 (0%) 1 (10.00%) 8 (80%) CANCER STAGE, n (%) Stage I Stage IV Unknown 2 (20%) 7 (70%) 1 (10%) HYPERTENSION, n (%) NO YES 6 (60%) 4 (40%) DIABETES, n (%) NO YES 7 (70%) 3 (30%) IMMUNOTHERAPY, n (%) Ipilimumab Pembrolizumab Nivolumab Atezolizumab 6 (60%) 2 (20%) 7 (70%) 2 (20%) IMMUNOTHERAPY TYPE, n (%)ANTI PD-1 ANTI PD-L1 ANTI PD-1 / ANTI PD-L1 ANTI CTLA-4 ANTI CTLA-4 WITH ANTI PD-1 4 (40%) 1 (10%) 1 (10%) 2 (20%) 4 (40%) CANCER TYPE Head and Neck Lung and Thorax GI 3 (30%) 3 (30%) 4 (40%)