SOCIETY FOR ENDOCRINOLOGY ENDOCRINE EMERGENCY GUIDANCE: Acute management of the endocrine complications of checkpoint inhibitor therapy

Higham, Claire; Olsson‐Brown, Anna; Carroll, Paul; Cooksley, Tim; Larkin, James; Lorigan, Paul; Morganstein, Daniel L.; Trainer, Peter

doi:10.1530/ec-18-0068

Cited by 110 publications

(158 citation statements)

References 20 publications

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“…Many guidelines and recommendations have been proposed in the last few years, for the acute management of hypophysitis or more generally on the management of endocrinopathies, based on the CTCAE (common terminology criteria for adverse events) (56,61) or based only on symptoms, blood and imaging data (62,63). Some authors have recently proposed detailed follow-up for patients with immunotherapy, to allow for early diagnosis and treatment of ICI-induced hypophysitis.…”

Section: To Conclude What Can We Currently Recommend For Ici-inducedmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Immune check point inhibitors-induced hypophysitis

Albarel

Castinetti

Brue

2019

European Journal of Endocrinology

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In recent years, the development of immunotherapy has constituted a revolution in the therapy for many cancers, with a specific toxicity profile including endocrine immune-related adverse events. Immune check point inhibitors (ICI)-induced hypophysitis is a common endocrine side effect, particularly with CTLA-4 antibodies and combination therapy, with frequent hormonal deficiencies at diagnosis. It can be difficult to evoke such diagnosis as the initial clinical symptoms are not specific (headache, asthenia…); thus, patients receiving such immunomodulatory therapies should be closely monitored by systematic hormone measurements, especially in the first weeks of treatment. Usually, hormonal deficiencies improve, except for corticotroph function. Despite a lack of large prospective studies on ICI-induced hypophysitis, some detailed longitudinal cohort studies have focused on such cases of hypophysitis and allow for optimal monitoring, follow-up and management of patients with this immune-related adverse event. In the case of ICI-induced hypophysitis, patients need long-term multidisciplinary follow-up, with specific education for those patients with corticotropin deficiency to allow them to be autonomous with their treatment. In this review, based on a clinical case, we detail the most relevant and novel aspects related to the incidence, diagnosis, treatment, evolution and management of hypophysitis induced by immunotherapy, with a focus on possible mechanisms and current recommendations and guidelines. Lastly, we emphasize several key points, such as the absence of indication to systematically treat with high-dose glucocorticoid and the pursuit of immunotherapy in such hypophysitis. These points should be kept in mind by oncologists and endocrinologists who treat and monitor patients treated by immunotherapy.

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Section: To Conclude What Can We Currently Recommend For Ici-inducedmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Immune check point inhibitors-induced hypophysitis

Albarel

Castinetti

Brue

2019

European Journal of Endocrinology

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“…In 2018, the American Society of Clinical Oncology [3] and the Society for Endocrinology in the UK [4] both published guidelines for the management of endocrine irAEs induced by ICIs. The Japan Endocrine Society also published the Japanese version of the guidelines in the same year [5].…”

Section: Introductionmentioning

confidence: 99%

Management of immune-related adverse events in endocrine organs induced by immune checkpoint inhibitors: clinical guidelines of the Japan Endocrine Society

et al. 2019

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Immune checkpoint inhibitors (ICIs) have become a promising treatment for advanced malignancies. However, these drugs can induce immune-related adverse events (irAEs) in several organs, including skin, gastrointestinal tract, liver, muscle, nerve, and endocrine organs. Endocrine irAEs comprise hypopituitarism, primary adrenal insufficiency, thyroid dysfunction, hypoparathyroidism, and type 1 diabetes mellitus. These conditions have the potential to lead to life-threatening consequences, such as adrenal crisis, thyroid storm, severe hypocalcemia, and diabetic ketoacidosis. It is therefore important that both endocrinologists and oncologists understand the clinical features of each endocrine irAE to manage them appropriately. This opinion paper provides the guidelines of the Japan Endocrine Society and in part the Japan Diabetes Society for the management of endocrine irAEs induced by ICIs.

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“…Acute cortisol deficiency may be life-threatening and early recognition and appropriate management is essential. Recent UK guidelines present endocrine assessment and management of acute life-threatening endocrine complications of ICP inhibitor therapies (26). Glucocorticoid replacement is suggested with the usual replacement dose of hydrocortisone (10+5+5 mg) or 7.5 mg prednisolone.…”

Section: Autoimmune Hypophysitis Related To Immune Checkpoint (Icp) Imentioning

confidence: 99%

DIAGNOSIS OF ENDOCRINE DISEASE: Drug-induced endocrinopathies and diabetes: a combo-endocrinology overview

Diamanti-Kandarakis

Duntas

Kanakis

et al. 2019

European Journal of Endocrinology

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In the currently overwhelming era of polypharmacy, the balance of the dynamic and delicate endocrine system can easily be disturbed by interfering pharmaceutical agents like medications. Drugs can cause endocrine abnormalities via different mechanisms, including direct alteration of hormone production, changes in the regulation of the feedback axis, on hormonal transport, binding and signaling, as well as similar changes to counter-regulatory hormone systems. Furthermore, drugs can interfere with the hormonal assays, leading to erroneous laboratory results that disorientate clinicians from the right diagnosis. The purpose of this review is to cover a contemporary topic, the drug-induced endocrinopathies, which was presented in the monothematic annual Combo Endo Course 2018. This challenging part of endocrinology is constantly expanding particularly during the last decade, with the new oncological therapeutic agents, targeting novel molecular pathways in the process of malignancies. In this new context of drug-induced endocrine disease, clinicians should be aware that drugs can cause endocrine abnormalities via different mechanisms and mimic a variety of clinical scenarios. Therefore, it is extremely important for clinicians not only to promptly recognize drug-induced hormonal and metabolic abnormalities, but also to address the therapeutic issues for timely intervention.

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SOCIETY FOR ENDOCRINOLOGY ENDOCRINE EMERGENCY GUIDANCE: Acute management of the endocrine complications of checkpoint inhibitor therapy

Cited by 110 publications

References 20 publications

MANAGEMENT OF ENDOCRINE DISEASE: Immune check point inhibitors-induced hypophysitis

MANAGEMENT OF ENDOCRINE DISEASE: Immune check point inhibitors-induced hypophysitis

Management of immune-related adverse events in endocrine organs induced by immune checkpoint inhibitors: clinical guidelines of the Japan Endocrine Society

DIAGNOSIS OF ENDOCRINE DISEASE: Drug-induced endocrinopathies and diabetes: a combo-endocrinology overview

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