[Endocrine Organ Dysfunction with Immune-Checkpoint Inhibitors]

Area of Science:

• Immunology and Oncology
• Endocrinology

Background:

• Immune-checkpoints, including Cytotoxic T-lymphocyte associated antigen 4 (CTLA-4) and programmed death 1 (PD-1), regulate T-cell activity.
• Immune-checkpoint inhibitors (ICIs) are novel cancer therapeutics that enhance anti-tumor immunity but can lead to immune-related adverse events (irAEs).
• Endocrine irAEs, affecting the pituitary, thyroid, pancreas, and adrenal glands, are serious and potentially fatal complications of ICI therapy.

Purpose of the Study:

• To discuss the mechanisms, diagnosis, and treatment of endocrine irAEs associated with ICI therapy.
• To emphasize the critical need for routine endocrine monitoring during ICI treatment.
• To highlight the importance of early detection and management of endocrine dysfunction in cancer patients receiving ICIs.

Main Methods:

• Review of current literature on immune-checkpoints, ICIs, and their associated endocrine adverse events.
• Discussion of proposed mechanisms underlying endocrine irAEs.
• Outline of diagnostic approaches and treatment strategies for endocrine irAEs.

Main Results:

• ICI therapy can cause significant endocrine irAEs, including pituitary, thyroid, pancreatic, and adrenal dysfunction.
• Symptoms such as fatigue, hyperglycemia, hypoglycemia, hypotension, and hyponatremia may indicate endocrine irAEs.
• Approximately 20-30% of advanced cancer patients respond to ICIs, underscoring the need to manage their side effects.

Conclusions:

• Routine monitoring of endocrine function and related symptoms is essential during ICI therapy.
• Prompt diagnosis and treatment of endocrine irAEs are critical to prevent severe complications and ensure patient safety.
• Further research into the mechanisms and management of endocrine irAEs will improve outcomes for cancer patients treated with ICIs.