Immune Checkpoint Inhibitors-Induced Endocrinopathies: Assessment, Management and Monitoring in a Comprehensive...

Area of Science:

• Endocrinology
• Oncology
• Immunology

Background:

• Immune checkpoint inhibitors (ICIs), specifically PD-1/PD-L1 inhibitors, are increasingly used for solid tumors.
• A significant number of patients treated with these agents develop endocrine-related adverse events (endocrinopathies).

Purpose of the Study:

• To determine the incidence, presentation, frequency, and management of ICI-related endocrinopathies in Oman.
• To specifically investigate endocrinopathies associated with PD-1/PD-L1 inhibitors.

Main Methods:

• Retrospective study conducted at Sultan Qaboos Comprehensive Cancer Care and Research Centre (SQCCCRC) from August 2021 to December 2022.
• Inclusion criteria: adults with solid cancers receiving at least one dose of ICIs.
• Exclusion criteria: incomplete data; data collected on ICI-induced endocrinopathy.

Main Results:

• 139 patients included; 58% female, median age 56 years.
• Incidence of endocrine-related adverse events was 28%, with a mean onset of 4.1 months post-treatment.
• Hypothyroidism (90%) was the most common, followed by hyperthyroidism. Hypophysitis, adrenal insufficiency, and type 1 diabetes mellitus occurred less frequently.
• Higher body mass index (BMI) was significantly associated with developing endocrine immune-related adverse events (irAEs).

Conclusions:

• This is the first study from Oman on PD-1/PDL-1 ICI-induced endocrinopathies.
• Thyroid dysfunction (hypothyroidism and hyperthyroidism) is the most frequent endocrine irAE.
• While less common, hypophysitis and adrenal insufficiency have a greater impact; higher BMI is a risk factor for irAEs. Physician awareness and screening are crucial.