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Autoimmune hepatitis, hypothyroidism and pneumonitis: 6 case reports In a retrospective chart review of 6 women aged 24–65 years, the women developed central hypothyroidism, focal pneumonitis or autoimmune hepatitis during treatment with mitotane, pembrolizumab or ketoconazole for metastatic adrenocortical carcinoma [outcomes not stated; not all dosages, routes, indications and times to reactions onsets stated]. All women were diagnosed with metastatic adrenocortical carcinoma. All 6 women received chemotherapy with mitotane. Out of these 6 women, 3 women, received mitotane along with doxorubicin [adriamycin], cyclophosphamide and etoposide (n=1), etoposide, doxorubicin, and cisplatin (n=1) and etoposide (n=1). Initial dose of mitotane was 500mg daily, which was subsequently titrated. Mitotane was administered with one tablespoon of flaxseed oil. All women developed glucocorticoid deficiency [aetiology not specified]. Hence, prednisone was added to the therapy. All women developed central hypothyroidism, which was a side effect of mitotane. Medications were adjusted in all women to treat central hypothyroidism. Subsequently, mitotane monotherapy or mitotane plus chemotherapy regimens failed (underlying disease progressed). Thus, IV pembrolizumab every 21 days was added to mitotane treatment (during July 2016 to March 2019). One woman out of the 6 women additionally received ketoconazole. One woman out of the 6 women developed focal pneumonitis following 27 cycles of pembrolizumab. Pembrolizumab was discontinued, and she had stable disease for more than 6 months with continued mitotane therapy. Another woman out of the 6 women developed grade 3 autoimmune hepatitis after receiving pembrolizumab for 8 months and ketoconazole for 2 months. She had stable disease, however due to the autoimmune hepatitis, the therapy was discontinued. After 8 months, she died due to disease progression. Head L, et al. Response to Immunotherapy in Combination with Mitotane in Patients with Metastatic Adrenocortical Cancer. Journal of the Endocrine Society 3: 2295-2304, 803449620 No. 12, Dec 2019. Available from: URL: http://doi.org/10.1210/js.2019-00305

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Reactions 25 Jan 2020 No. 1788