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Endocrine Toxicity and Outcomes in Patients With Metastatic Malignancies Treated With Immune Checkpoint Inhibitors

Suleiman I Al Ashi1, Bicky Thapa1, Monica Flores1

  • 1Internal Medicine Department, Cleveland Clinic-Fairview Hospital, Cleveland, OH, USA.

Journal of the Endocrine Society
|July 1, 2021
PubMed
Abstract

Insights

Immune checkpoint inhibitors (ICIs) can cause endocrine events, but these may signal better cancer response and survival. Melanoma patients and those on ipilimumab face higher risks.

Area of Science:

  • Oncology
  • Endocrinology
  • Immunotherapy

Background:

  • Immune checkpoint inhibitors (ICIs) revolutionized advanced cancer treatment.
  • Immune-related endocrine events (irEEs) are a known side effect of ICIs.
  • Early diagnosis of irEEs is challenging due to nonspecific symptoms and varied onset.

Purpose of the Study:

  • To identify risk factors for irEEs.
  • To determine the timeline of irEEs development.
  • To assess the prognosis associated with irEEs.

Main Methods:

  • Retrospective observational study at Cleveland Clinic.
  • Included adult patients with metastatic cancer receiving ICIs.
  • Reviewed 551 patient charts for demographics, ICI type, endocrine toxicities, cancer response, and survival.

Main Results:

  • Median time to irEEs diagnosis was 9 weeks.
  • Melanoma (31.3%) and ipilimumab (29.4%) were associated with higher irEE incidence.
  • Patients with irEEs showed better cancer response (45% vs 28.3%) and survival (P < 0.001).

Conclusions:

  • irEEs in patients on ICIs may predict favorable tumor response and prognosis.
  • Higher irEE incidence linked to ipilimumab, combination ICI therapy, and melanoma.
  • irEEs, particularly pituitary insufficiency, can be severe and irreversible with ipilimumab.
Keywords:
cancerendocrine toxicitiesimmune-checkpoint inhibitorsimmune-related adverse events

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