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Thyroid-related adverse events induced by immune checkpoint inhibitors
Alexandra Chera1,2, Andreea Lucia Stancu3, Octavian Bucur1,4
1Victor Babes National Institute of Pathology, Bucharest, Romania.
Abstract:
Immune checkpoint inhibitors, namely anti-CTLA-4, anti-PD-1 and anti-PD-L1 monoclonal antibodies, have emerged in the last decade as a novel form of cancer treatment, promoting increased survival in patients. As they tamper with the immune response in order to destroy malignant cells, a new type of adverse reactions has emerged, known as immune-related adverse events (irAEs), which frequently target the endocrine system, especially the thyroid and hypophysis. Thyroid irAEs include hyperthyroidism, thyrotoxicosis, hypothyroidism and a possibly life-threatening condition known as the "thyroid storm". Early prediction of occurrence and detection of the thyroid irAEs should be a priority for the clinician, in order to avoid critical situations. Moreover, they are recently considered both a prognostic marker and a means of overseeing treatment response, since they indicate an efficient activation of the immune system. Therefore, a multidisciplinary approach including both oncologists and endocrinologists is recommended when immune checkpoint inhibitors are used in the clinic.
Insights
Immune checkpoint inhibitors improve cancer survival but can cause endocrine side effects, particularly impacting the thyroid. Early detection of these thyroid immune-related adverse events is crucial for patient management and monitoring treatment efficacy.
Area of Science:
- Oncology
- Endocrinology
- Immunology
Background:
- Immune checkpoint inhibitors (ICIs) like anti-CTLA-4, anti-PD-1, and anti-PD-L1 antibodies have revolutionized cancer therapy, improving patient survival.
- ICIs modulate the immune system to target cancer cells, leading to a unique class of side effects known as immune-related adverse events (irAEs).
- Endocrine organs, particularly the thyroid and pituitary gland, are frequent targets of irAEs.
Purpose of the Study:
- To highlight the significance of thyroid immune-related adverse events (irAEs) associated with immune checkpoint inhibitor therapy.
- To emphasize the need for early prediction and detection of thyroid irAEs to prevent severe complications.
- To discuss the emerging role of thyroid irAEs as prognostic markers and indicators of treatment response.
Main Methods:
- Review of current literature on immune checkpoint inhibitors and their associated endocrine toxicities.
- Analysis of the clinical manifestations and management of thyroid irAEs.
- Discussion of the implications of thyroid irAEs in cancer treatment monitoring.
Main Results:
- Thyroid irAEs encompass a spectrum of conditions including hyperthyroidism, thyrotoxicosis, hypothyroidism, and potentially life-threatening thyroid storm.
- Early identification of thyroid irAEs is critical for effective clinical management and prevention of adverse outcomes.
- Thyroid irAEs are increasingly recognized as valuable indicators of immune system activation, treatment efficacy, and patient prognosis.
Conclusions:
- Immune checkpoint inhibitors offer significant survival benefits in cancer treatment but necessitate vigilant monitoring for endocrine irAEs.
- A multidisciplinary approach involving oncologists and endocrinologists is essential for managing patients receiving ICIs, particularly concerning thyroid function.
- Understanding and managing thyroid irAEs is paramount for optimizing cancer therapy and patient outcomes.
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