Endocrine adverse events related with immune checkpoint inhibitors: an update for clinicians

Area of Science:

• Oncology
• Immunology
• Endocrinology

Background:

• Immune checkpoint inhibitors (ICIs) represent a major advance in cancer therapy by targeting CTLA-4 and PD-1/PD-L1 pathways.
• ICIs restore anti-tumor immune responses but are associated with immune-related adverse events (irAEs).
• Endocrine irAEs are a significant concern due to their unique clinical characteristics.

Purpose of the Study:

• To review the endocrine irAEs associated with immune checkpoint inhibitors.
• To highlight the distinct features of endocrine irAEs, including onset, irreversibility, and diagnostic challenges.
• To provide a framework for managing these adverse events.

Main Methods:

• Literature review focusing on endocrine immune-related adverse events.
• Analysis of clinical presentation, diagnosis, and management strategies.
• Synthesis of current guidelines and future perspectives.

Main Results:

• Endocrine irAEs exhibit unpredictable onset, irreversibility, nonspecific symptoms, and a broad clinical spectrum.
• Diagnosis often requires a sophisticated work-up.
• Current guidelines emphasize individualized decision-making for patient management.

Conclusions:

• Endocrine irAEs pose unique challenges in ICI therapy.
• A proactive approach focusing on prevention, anticipation, detection, treatment, and monitoring is essential.
• Optimizing cancer treatment benefits while minimizing endocrine immunotoxicity requires careful clinical judgment.