ABSRACT
Objectives: To estimate the prevalence and the types of immune endocrine dysfunction associated with use of immune check point inhibitors used for treatment of solid tumours.
Methods: This retrospective observational study reviews the types and frequency of the endocrinopathies associated with immune checkpoint inhibitors available to date among a large cohort of patients attending a local tertiary oncology centre.
Results: A total of 234 patients undergoing treatment with a check-point inhibitor treatment were recruited, most patients 214 (91.4%) received single therapy whilst only 20 (8.6%) received combination therapy. The overall prevalence of adverse events in this group was 15.0 per 100 with a 95% confidence interval of (11.0-21.1). Subclinical thyroid disorders, including subclinical hypothyroid and subclinical hyperthyroid, occurred for 6.4 and 12.4% of patients, respectively. Among our cohort, thyroid disorders including both hyperthyroid and hypothyroid was the most common endocrine adverse event with prevalence of 7.7% and 5.1%, with a 95% confidence interval of (4.9-11.9) and (3.0-8.7) respectively.
Conclusion: Despite its considerable benefit in patients with cancer, immune checkpoint blockade can be limited by the occurrence of irAEs that can be life threatening. Although certain endocrine adverse events are frequent during cancer immune-therapy, their management is relatively uncomplicated. Thyroid dysfunction and hypophysitis are the most common abnormalities.
Practice Implications: In our view, clinical and biochemical screening of endocrine toxicity would improve our knowledge of physio-pathological mechanisms as well as help modify our management and in preventing severe events.
KEYWORDS:
Adverse events, Endocrine toxicity, Checkpoint inhibitors, Immunotherapy, Thyroid dysfunction, Hypophysitis, Type 1 diabetes mellitus, and Adrenal insufficiency