Endocrine toxicity of immune checkpoint inhibitors: essential crosstalk between endocrinologists and oncologists

Cancer Med. 2017 Aug;6(8):1923-1929. doi: 10.1002/cam4.1145. Epub 2017 Jul 18.

Abstract

Two types of immune checkpoint inhibitors, both antibodies that target cytotoxic T-lymphocyte antigen-4 and those that target programmed cell death-protein 1, have been approved for use in melanoma, non-small-cell lung cancer, and renal cell carcinoma as first-line or second-line therapy. Their adverse events are primarily regarded as immune-related adverse events. We felt it was important to pinpoint and discuss certain preconceptions or misconceptions regarding thyroid dysfunction, hypophysitis, and diabetes induced by immune checkpoint inhibitors. We have identified areas of uncertainty and unmet requirements, including essential interaction between endocrinologists and oncologists. Five issues have been identified for discussion: (1) diagnosis of endocrine toxicity, (2) assessment of toxicity severity, (3) treatment of toxicity, (4) withdrawal or continuation of immunotherapy, (5) preventive action.

Keywords: Adverse events; endocrine toxicity; immune checkpoint inhibitors; immunotherapy; thyroid dysfunction.

Publication types

  • Review

MeSH terms

  • Antibodies, Monoclonal / adverse effects
  • Antineoplastic Agents, Immunological / adverse effects*
  • B7-H1 Antigen / antagonists & inhibitors
  • Biomarkers, Tumor
  • CTLA-4 Antigen / antagonists & inhibitors
  • Clinical Decision-Making
  • Disease Management
  • Endocrine System / drug effects*
  • Endocrine System Diseases / diagnosis
  • Endocrine System Diseases / etiology
  • Endocrine System Diseases / prevention & control
  • Endocrine System Diseases / therapy
  • Endocrinologists
  • Humans
  • Immunomodulation / drug effects*
  • Immunotherapy
  • Interdisciplinary Communication
  • Oncologists
  • Programmed Cell Death 1 Receptor / antagonists & inhibitors
  • Severity of Illness Index

Substances

  • Antibodies, Monoclonal
  • Antineoplastic Agents, Immunological
  • B7-H1 Antigen
  • Biomarkers, Tumor
  • CTLA-4 Antigen
  • Programmed Cell Death 1 Receptor