Bone disorders in oncological patients treated with Immune-Checkpoint Inhibitors (ICIs)

Vasiliki Siampanopoulou; Anna Angelousi; George Lyrarakis; Athina Karampela; Petros Papalexis; Alexandros Lafioniatis; Chrysoula Mytareli; Elisavet Tasouli; Dimitrios Ziogas; Evanthia Kassi; Helen Gogas

doi:10.1530/endoabs.99.EP334

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Endocrine Abstracts (2024) 99 EP334 | DOI: 10.1530/endoabs.99.EP334

ECE2024 Eposter Presentations Calcium and Bone (102 abstracts)

Bone disorders in oncological patients treated with Immune-Checkpoint Inhibitors (ICIs)

Vasiliki Siampanopoulou ¹ , Anna Angelousi ¹ , George Lyrarakis ² , Athina Karampela ¹ , Petros Papalexis ¹ , Alexandros Lafioniatis ¹ , Chrysoula Mytareli ¹ , Elisavet Tasouli ¹ , Dimitrios Ziogas ² , Evanthia Kassi ^3,4 & Helen Gogas ²

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¹Unit of Endocrinology, First Department of Internal Medicine, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece; ²First Department of Internal Medicine, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece; ³Unit of Endocrinology, First Department of Propaedeutic and Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece; ⁴Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece

Background: The use of immune checkpoint inhibitors (ICIs) has been lately established as a promising and effective treatment in several solid malignancies. Endocrine-related adverse effects are common, however their effects on bone metabolism is unknown.

Methods: We retrospectively investigated the prevalence of bone-related complications in patients undergoing or completing treatment with ICIs. Epidemiological and clinical data from the medical files of 72 patients treated mainly for melanoma (90.2%) were recorded. Bone health metrics were determined by Dual Energy X-ray Absorptiometry (DEXA) scans and biochemical markers.

Results: In this study, a total of 72 patients were included, with a female to male ratio (54% vs 46%) and a mean age of 59.2 years for women and 64.8 years for men. Monotherapy with ICIs was administered in 48.6% of the cases, with nivolumab being the most common type (36.1%). Sequential and/or combination treatments were also administrated in 26.3% of the patients, including chemotherapy+ ICI (9.8%), sequential ICIs (8.3%), Interferon A+ ICI (4.1%) and Tyrosine Kinase Inhibitors (TKIs) + ICIs (4.1%). DEXA scans revealed normal bone density in 48.6% of the cases, osteopenia in 36.1% and osteoporosis in 15.2%. In all cases, bone density data were acquired in a mean time of 22.7 months post-ICI initiation. It should be noted that the patients with osteopenia or osteoporosis had no prior personal history of bone disease and did not receive any antiosteoporotic medication. No osteoporotic fractures were reported in any of our patients. Mean osteocalcin (BGP) levels in patients with osteoporosis and osteopenia were statistically significantly higher compared to those with normal DEXA [28 ± 11.6 ng/ml (p-value=0.016) and 22.8 ± 9.1 ng/ml (p-value=0.013) accordingly, vs 16.4 ± 9.8 ng/ml (p-value=0.315)].

Conclusions: Our findings suggest that bone health issues have a significant prevalence among oncological patients treated with ICI irrespective of the treatment schemes. Bone health is a parameter that should not be underestimated in oncological patients.