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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
PubMed

Insights

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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