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The Current Understanding of the Endocrine Effects From Immune Checkpoint Inhibitors and Recommendations for
Monica Girotra1, Aaron Hansen2, Azeez Farooki1
1Endocrine Division, Department of Medicine, Weill Cornell Medical College.
JNCI Cancer Spectrum
|July 31, 2018
Summary
Immune checkpoint inhibitors revolutionize cancer treatment but can cause endocrine immune-related adverse events (IRAEs). This review details mechanisms, presentations, and management strategies for these unique toxicities.
Area of Science:
- Immunology
- Endocrinology
- Oncology
Background:
- Immune checkpoint inhibitors (ICIs) targeting CTLA-4 and PD-1/PD-L1 are established cancer therapies.
- ICI treatment can lead to immune-related adverse events (IRAEs), including endocrine toxicities.
- Endocrine IRAEs present uniquely compared to traditional chemotherapy side effects.
Purpose of the Study:
- To review the mechanisms and clinical presentations of endocrine IRAEs.
- To propose management guidelines and algorithms for these conditions.
- To suggest future research directions for optimizing detection and treatment.
Main Methods:
- Literature review of clinical trials and mechanistic studies.
- Synthesis of current hypotheses on ICI-induced endocrinopathies.
- Development of evidence-based management recommendations.
Main Results:
- Endocrine IRAEs include hypophysitis, thyroid dysfunction, and diabetes mellitus.
- Mechanisms involve disruption of immune tolerance and T-cell mediated autoimmunity.
- Distinct clinical profiles necessitate specific diagnostic and management approaches.
Conclusions:
- Understanding ICI-induced endocrine IRAEs is crucial for patient safety.
- Standardized management protocols can improve patient outcomes.
- Further research is needed to refine treatment strategies and predictive biomarkers.
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