SHARE @ Advocate Health - Midwest - Scientific Day: Immune Checkpoint Inhibitor Complications in Triple Negative Breast Cancer: Evaluating Oncologist Monitoring and Management of Adrenal Insufficiency and Hypophysitis
 

Affiliations

Aurora Sinai Medical Center, Aurora UW Medical Group

Abstract

Background/Significance:

Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer. The KEYNOTE-522 Protocol (PROTOCOL), combining standard-of-care chemotherapy with pembrolizumab improves outcomes but notably risks adrenal insufficiency (AI). Guidelines lack standardized recommendations for routine testing in patients leading to varied practice among oncologists within the Aurora Legacy system, Wisconsin (AURORA).

Purpose:

This quality improvement project evaluates adrenocorticotropic hormone (ACTH) and cortisol testing patterns in TNBC patients undergoing neoadjuvant pembrolizumab per PROTOCOL within AURORA. The goal is to enhance care by optimizing the monitoring and management of potential AI related to pembrolizumab.

Methods:

Utilizing Advocate Health Midwest cancer registry data, we identified TNBC patients receiving neoadjuvant treatment per PROTOCOL between February 1, 2020, and March 31, 2024, within AURORA. Data was obtained through research analytics and manual chart review. Primary outcomes were ACTH and cortisol testing patterns. Secondary outcomes included TNBC frequency and adrenal insufficiency prevalence.

Results:

384 TNBC patients were identified. 123 were found to be treated per PROTOCOL. 55 patients (44.7%) were tested for AI, regardless of symptoms. 238 tests were performed (4.3 tests/patient averaged). Most patients (54.4%) had 1-2 tests, while one patient had 28. Cortisol testing (66.8%) was more common than ACTH (33.2%). 7 patients (12.7%) of those tested were found to have pembrolizumab-associated AI.

Conclusion:

This study noted variability in AI testing patterns for TNBC patients receiving pembrolizumab. On chart review, approaches ranged from routine screening to symptom-based testing, with fatigue as the main trigger for testing. Notably, fatigue’s prevalence in chemotherapy complicates its interpretation as an indicator. Based on our research, we propose a standardized testing protocol.

Presentation Notes

Presented at Scientific Day; May 21, 2025; Park Ridge, IL.

Full Text of Presentation

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Document Type

Oral/Podium Presentation


 

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Immune Checkpoint Inhibitor Complications in Triple Negative Breast Cancer: Evaluating Oncologist Monitoring and Management of Adrenal Insufficiency and Hypophysitis

Background/Significance:

Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer. The KEYNOTE-522 Protocol (PROTOCOL), combining standard-of-care chemotherapy with pembrolizumab improves outcomes but notably risks adrenal insufficiency (AI). Guidelines lack standardized recommendations for routine testing in patients leading to varied practice among oncologists within the Aurora Legacy system, Wisconsin (AURORA).

Purpose:

This quality improvement project evaluates adrenocorticotropic hormone (ACTH) and cortisol testing patterns in TNBC patients undergoing neoadjuvant pembrolizumab per PROTOCOL within AURORA. The goal is to enhance care by optimizing the monitoring and management of potential AI related to pembrolizumab.

Methods:

Utilizing Advocate Health Midwest cancer registry data, we identified TNBC patients receiving neoadjuvant treatment per PROTOCOL between February 1, 2020, and March 31, 2024, within AURORA. Data was obtained through research analytics and manual chart review. Primary outcomes were ACTH and cortisol testing patterns. Secondary outcomes included TNBC frequency and adrenal insufficiency prevalence.

Results:

384 TNBC patients were identified. 123 were found to be treated per PROTOCOL. 55 patients (44.7%) were tested for AI, regardless of symptoms. 238 tests were performed (4.3 tests/patient averaged). Most patients (54.4%) had 1-2 tests, while one patient had 28. Cortisol testing (66.8%) was more common than ACTH (33.2%). 7 patients (12.7%) of those tested were found to have pembrolizumab-associated AI.

Conclusion:

This study noted variability in AI testing patterns for TNBC patients receiving pembrolizumab. On chart review, approaches ranged from routine screening to symptom-based testing, with fatigue as the main trigger for testing. Notably, fatigue’s prevalence in chemotherapy complicates its interpretation as an indicator. Based on our research, we propose a standardized testing protocol.

 

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