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Iipilimumab irAE – endocrynopathy management

Forums General Melanoma Community Iipilimumab irAE – endocrynopathy management

  • Post
    Mikers
    Participant

      Hello!

      I wonder which steroids did you use and how did you tapper them if you have had an endocrinopaty namely pituitary inflammation?

      Did you suspend ipi and for how long?

      Did you use antibiotics? 

      How long did it take to resolve syptoms?

      Did you make lumber puncture for proper diagnoses?

      Thank you!

      My Doc is not an expert in the field and I want to help him )

       

       

    Viewing 5 reply threads
    • Replies
        debwray
        Participant

          Hi Mikers,

          Similar IRAE profile for Keytruda- This is the management tool….

          https://www.keytruda.com/static/pdf/adverse-reaction-management-tool.pdf

          which gives advice for how this is handled with this drug.. would think the protocols would be similar for both drugs.

          This is a link to a scientific paper that discusses ipi and pituitary inflammation

          http://www.ncbi.nlm.nih.gov/pubmed/25078147   sorry not personal experience but might be worth letting your doc see…

          All the best

          Deb

           

           

           

            Mikers
            Participant

              Thank you, Deb, very useful paper!

              Mikers
              Participant

                Thank you, Deb, very useful paper!

                Mikers
                Participant

                  Thank you, Deb, very useful paper!

                debwray
                Participant

                  Hi Mikers,

                  Similar IRAE profile for Keytruda- This is the management tool….

                  https://www.keytruda.com/static/pdf/adverse-reaction-management-tool.pdf

                  which gives advice for how this is handled with this drug.. would think the protocols would be similar for both drugs.

                  This is a link to a scientific paper that discusses ipi and pituitary inflammation

                  http://www.ncbi.nlm.nih.gov/pubmed/25078147   sorry not personal experience but might be worth letting your doc see…

                  All the best

                  Deb

                   

                   

                   

                  debwray
                  Participant

                    Hi Mikers,

                    Similar IRAE profile for Keytruda- This is the management tool….

                    https://www.keytruda.com/static/pdf/adverse-reaction-management-tool.pdf

                    which gives advice for how this is handled with this drug.. would think the protocols would be similar for both drugs.

                    This is a link to a scientific paper that discusses ipi and pituitary inflammation

                    http://www.ncbi.nlm.nih.gov/pubmed/25078147   sorry not personal experience but might be worth letting your doc see…

                    All the best

                    Deb

                     

                     

                     

                    MoiraM
                    Participant

                      I am in the UK.

                      I was treated with 3mg/kg Ipi – four infusions at three week intervals. In the UK, the standard treatment does not include maintenence doses.

                      I developed hypophysitis (inflamation of the pituitary gland) after my fourth infusion. As it was my last infusion, it did not affect my treatment with Ipi.

                      I became very unwell (headaches, increasing fatigue, no appetite, swollen ankles, poor balance) and was diagnosed through a blood test that measured hormone levels. I also had an MRI but that was later. No mention was made of a lumbar puncture and I cannot see that it would have shown anything. Antibiotics only work for bacteria infections. Hypophystis triggered by Ipi is more like an autoimmune condition.

                      I was referred to an endocrinologist by my melanoma specialist.

                      I have zero anterior pituitary gland function and have been that way for over a year now.

                      I was never put on high dose steroids to control the inflamation. To be honest, I think the damage had been done by the time I was diagnosed so high dose steroids would have just made matters worse. I was put on close to replacement levels of the missing hormones.

                      I was put on 10mg/day prednisolone and 75 mcg/day levothryroxine. As I am female, I did not need any tetesterone replacement. As I am an older female, I do not need replacement female hormones.

                      I am now on 8mg/day prednisolone (which is considered slightly high) and 82.5 mcg/day leveothyroxine.

                       

                        Mikers
                        Participant

                          Thank you, Moira! Do you remember which hormone tests were wrong? Were values increased or decreased and how much?
                           

                          Mikers
                          Participant

                            Thank you, Moira! Do you remember which hormone tests were wrong? Were values increased or decreased and how much?
                             

                            Mikers
                            Participant

                              Thank you, Moira! Do you remember which hormone tests were wrong? Were values increased or decreased and how much?
                               

                              MoiraM
                              Participant

                                My cortisol levels were undetectably low.

                                My 'T4' test was also adnormal. This is a test that they do when the test for thyroxine indicates that thyroxine levels are too low. I cannot remember the actual numbers.

                                MoiraM
                                Participant

                                  My cortisol levels were undetectably low.

                                  My 'T4' test was also adnormal. This is a test that they do when the test for thyroxine indicates that thyroxine levels are too low. I cannot remember the actual numbers.

                                  MoiraM
                                  Participant

                                    My cortisol levels were undetectably low.

                                    My 'T4' test was also adnormal. This is a test that they do when the test for thyroxine indicates that thyroxine levels are too low. I cannot remember the actual numbers.

                                  MoiraM
                                  Participant

                                    I am in the UK.

                                    I was treated with 3mg/kg Ipi – four infusions at three week intervals. In the UK, the standard treatment does not include maintenence doses.

                                    I developed hypophysitis (inflamation of the pituitary gland) after my fourth infusion. As it was my last infusion, it did not affect my treatment with Ipi.

                                    I became very unwell (headaches, increasing fatigue, no appetite, swollen ankles, poor balance) and was diagnosed through a blood test that measured hormone levels. I also had an MRI but that was later. No mention was made of a lumbar puncture and I cannot see that it would have shown anything. Antibiotics only work for bacteria infections. Hypophystis triggered by Ipi is more like an autoimmune condition.

                                    I was referred to an endocrinologist by my melanoma specialist.

                                    I have zero anterior pituitary gland function and have been that way for over a year now.

                                    I was never put on high dose steroids to control the inflamation. To be honest, I think the damage had been done by the time I was diagnosed so high dose steroids would have just made matters worse. I was put on close to replacement levels of the missing hormones.

                                    I was put on 10mg/day prednisolone and 75 mcg/day levothryroxine. As I am female, I did not need any tetesterone replacement. As I am an older female, I do not need replacement female hormones.

                                    I am now on 8mg/day prednisolone (which is considered slightly high) and 82.5 mcg/day leveothyroxine.

                                     

                                    MoiraM
                                    Participant

                                      I am in the UK.

                                      I was treated with 3mg/kg Ipi – four infusions at three week intervals. In the UK, the standard treatment does not include maintenence doses.

                                      I developed hypophysitis (inflamation of the pituitary gland) after my fourth infusion. As it was my last infusion, it did not affect my treatment with Ipi.

                                      I became very unwell (headaches, increasing fatigue, no appetite, swollen ankles, poor balance) and was diagnosed through a blood test that measured hormone levels. I also had an MRI but that was later. No mention was made of a lumbar puncture and I cannot see that it would have shown anything. Antibiotics only work for bacteria infections. Hypophystis triggered by Ipi is more like an autoimmune condition.

                                      I was referred to an endocrinologist by my melanoma specialist.

                                      I have zero anterior pituitary gland function and have been that way for over a year now.

                                      I was never put on high dose steroids to control the inflamation. To be honest, I think the damage had been done by the time I was diagnosed so high dose steroids would have just made matters worse. I was put on close to replacement levels of the missing hormones.

                                      I was put on 10mg/day prednisolone and 75 mcg/day levothryroxine. As I am female, I did not need any tetesterone replacement. As I am an older female, I do not need replacement female hormones.

                                      I am now on 8mg/day prednisolone (which is considered slightly high) and 82.5 mcg/day leveothyroxine.

                                       

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