Título:	Tratamento oncológico com imunoterápicos apresenta risco de hipofiste e hipopituitarismo? : revisão sistemática de incidência e características clínico-epidemiológicas
Autor(es):	Jacques, Juliana Prudêncio
E-mail do autor:	julijacques@gmail.com
Orientador(es):	Naves, Luciana Ansaneli
Assunto:	Hipofisite Hipopituitarismo Câncer Munobiológicos Imunoterapia
Data de publicação:	9-jul-2021
Data de defesa:	15-abr-2021
Referência:	JACQUES, Juliana Prudêncio. Tratamento oncológico com imunoterápicos apresenta risco de hipofiste e hipopituitarismo?: revisão sistemática de incidência e características clínico-epidemiológicas. 2021. 153 f., il. Dissertação (Mestrado em Ciências da Saúde)—Universidade de Brasília, Brasília, 2021.
Abstract:	In recent years, an increasing number of cancer cases has been described worldwide. In Brazil, according to the National Cancer Institute (INCA), it is estimated for each year of the 2020-2022 triennium the occurrence of 600 thousand new cases of cancer, for each year. The treatment against cancer has made important advances and immunotherapy has consolidated itself as one of the antineoplastic therapeutic pillars in the last decade, mainly with the advancement of the development and implementation of immunotherapeutic agents. This treatment potentiates and modulates the anti-tumor action of the immune system and, as a consequence, it can alter immunological tolerance, increasing the risk of autoimmune diseases. The adverse effects resulting from the increase in autoimmunity are called immune-mediated adverse effects (irAEs) and, among the endocrine disorders observed as irAEs, one of the main is hypophysitis and the consequent hypopituitarism. The aim of this study was to describe the frequency of hypophysitis and hypopituitarism, in addition to hormonal deficiencies in cancer patients who are undergoing antineoplastic treatment with immunobiological agents and to present the clinical and epidemiological profile of these patients. For this purpose, the meta-analysis resource was used. A search for articles was conducted on May 8-9, 2020 in the following databases: Medline (Pubmed), Embase, Web of Science, Clinicaltrials.gov, CENTRAL (Cochrane Controlled Register of trials) and gray literature. A manual search for references on relevant works and on other revisions was also carried out. This strategy resulted in a total of 2830 selected articles, where, after undergoing evaluation processes, 236 articles remained to be part of the analysis of the present work. The incidence of hypophysitis found ranged from 0% to 27.59%. If separated by type of study, the incidences varied: for cohort studies 0% to 27.59%, for non-randomized clinical trials 0% to 25% and for randomized clinical trials 0% to 16.21%. For hypopituitarism, the incidence of cases ranged from 0% to 33% of affected patients, the maximum frequency being 17.86% in cohort studies, 14.67% in non-RCTs and 33.33% in RCTs. A higher incidence of hypophysitis was found in elderly men, presenting with symptoms such as weakness and headache. The most common hormonal changes were those of the corticotrophic, thyrotrophic and gonadotrophic axes. In MRI, the main findings were pituitary enlargement and an increase in uptake. The main type of cancer being treated in the reviewed studies was melanoma (54,48%). Regarding geographic location, North America was the region with the highest origin of the individual cases described as well as the largest volume of publications of this type. For the studies used to assess incidence, the USA concentrates the majority of cohorts and non- randomized clinical trials. As for the randomized clinical trials, most were multicentric, with several countries involved in data collection. The evaluation of the quality of the studies showed that an important percentage of the publications presented a moderate and high risk of bias, and the main limitations observed in each study were presented. Knowledge of these data is important because it can help the assistant team in early recognition, in the best course of treatment and in the proper management of possible acute and chronic complications resulting from the treatment of cancer with immunotherapy.
Unidade Acadêmica:	Faculdade de Ciências da Saúde (FS)
Informações adicionais:	Dissertação (mestrado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Ciências da Saúde, 2021.
Programa de pós-graduação:	Programa de Pós-Graduação em Ciências da Saúde
Licença:	A concessão da licença deste item refere-se ao termo de autorização impresso assinado pelo autor com as seguintes condições: Na qualidade de titular dos direitos de autor da publicação, autorizo a Universidade de Brasília e o IBICT a disponibilizar por meio dos sites www.bce.unb.br, www.ibict.br, http://hercules.vtls.com/cgi-bin/ndltd/chameleon?lng=pt&skin=ndltd sem ressarcimento dos direitos autorais, de acordo com a Lei nº 9610/98, o texto integral da obra disponibilizada, conforme permissões assinaladas, para fins de leitura, impressão e/ou download, a título de divulgação da produção científica brasileira, a partir desta data.
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