Endocrine toxicity of cancer immunotherapy: clinical challenges

Anderson, Bliss; Morganstein, Daniel L.

doi:10.1530/ec-20-0489

Cited by 16 publications

(19 citation statements)

References 79 publications

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“…Autoimmune endocrinopathies are well described and include thyroid diseases, hypopituitarism, and type-1-like diabetes. The latter, contrarily to other autoimmune complications, do not resolve after CPI interruption, may be life-threatening and often require lifelong hormonal replacement [108]. Neurologic involvement is rare and included central and peripheral nervous system diseases associated with neural specific autoantibodies, vasculitis, granulomatous and demyelinating disorders, with an unfavorable outcome in up to 30% of patients [109].…”

Section: Autoimmune Complications Associated With Old and New Anti-cancer Drugsmentioning

confidence: 99%

Autoimmune Complications in Hematologic Neoplasms

Barcellini

Giannotta

Fattizzo

2021

Cancers

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Autoimmune cytopenias (AICy) and autoimmune diseases (AID) can complicate both lymphoid and myeloid neoplasms, and often represent a diagnostic and therapeutic challenge. While autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP) are well known, other rarer AICy (autoimmune neutropenia, aplastic anemia, and pure red cell aplasia) and AID (systemic lupus erythematosus, rheumatoid arthritis, vasculitis, thyroiditis, and others) are poorly recognized. This review analyses the available literature of the last 30 years regarding the occurrence of AICy/AID in different onco-hematologic conditions. The latter include chronic lymphocytic leukemia (CLL), lymphomas, multiple myeloma, myelodysplastic syndromes (MDS), chronic myelomonocytic leukemia (CMML), myeloproliferative neoplasms, and acute leukemias. On the whole, AICy are observed in up to 10% of CLL and with higher frequencies in certain subtypes of non-Hodgkin lymphoma, whilst they occur in less than 1% of low-risk MDS and CMML. AID are described in up to 30% of myeloid and lymphoid patients, including immune-mediated hemostatic disorders (acquired hemophilia, thrombotic thrombocytopenic purpura, and anti-phospholipid syndrome) that may be severe and fatal. Additionally, AICy/AID are found in about 10% of patients receiving hematopoietic stem cell transplant or treatment with new checkpoint inhibitors. Besides the diagnostic difficulties, these AICy/AID may complicate the clinical management of already immunocompromised patients.

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Section: Autoimmune Complications Associated With Old and New Anti-cancer Drugsmentioning

confidence: 99%

Autoimmune Complications in Hematologic Neoplasms

Barcellini

Giannotta

Fattizzo

2021

Cancers

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“…However, ICI may trigger several autoimmunity/autoinflammatory adverse events (irAEs) intimately related to their mechanism of action, i.e., the selective stimulation of the host immune system ( 48 , 50 ). Endocrine irAEs are among the most frequent ICI-related toxicities, being thyroid and pituitary dysfunction prevalent ( 51 – 53 ).…”

Section: In Cancer Patientsmentioning

confidence: 99%

Grading Central Diabetes Insipidus Induced by Immune Checkpoint Inhibitors: A Challenging Task

et al. 2022

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Central diabetes insipidus (CDI) is a rare endocrine disease deriving from an insufficient production or secretion of anti-diuretic hormone. Recently, CDI has been reported as a rare side effect triggered by immune checkpoint inhibitors (ICI) in cancer patients. Despite its current rarity, CDI triggered by ICI is expected to affect an increasing number of patients because of the expanding use of these effective drugs in a growing number of solid and hematologic malignancies. An appropriate assessment of the severity of adverse events induced by anticancer agents is crucial in their management, including dosing adjustment and temporary withdrawal or discontinuation treatment. However, assessment of the severity of CDI induced by ICI may be challenging, as its main signs and symptoms (polyuria, dehydration, weight loss, and hypernatremia) can be incompletely graded. Indeed, the current grading system of toxicity induced by anticancer treatments does not include polyuria. Additionally, dehydration in patients affected by diabetes insipidus, including ICI-induced CDI, is different in certain aspects from that due to other conditions seen in cancer patients, such as vomiting and diarrhea. This prompted us to reflect on the need to grade polyuria, and how to grade it, and to consider a specific grading system for dehydration associated with CDI induced by ICI. Here we propose a new grading system for polyuria and dehydration, as critical symptoms of the CDI syndrome occurring in patients on ICI treatment, to obtain better management of both the adverse event and the triggering drugs.

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“…Unlike other irAEs, endocrinopathies tend to be persistent and usually need lasting hormonal replacement, and if untreated can prove to be fatal. 45 Both anti-CTLA-4 and anti-PD-1 agents can lead to thyroid disorders, hypophysitis, and insulin-dependent diabetes. 46 The elusive and nonspecific symptoms associated with endocrinopathies such as fatigue may create difficulties in distinguishing them from any pre-existent comorbidities.…”

Section: Endocrinementioning

confidence: 99%

Immune-Related Adverse Events (irAEs) in Cancer, with Inputs from a Nursing Expert: A Review

Buch

Baba

2022

Indian J Med Paediatr Oncol

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Immune checkpoint inhibitors (ICPis) belong to a group of immunotherapeutic agents that act on different immune cells and tumor cells and reactivate the suppressed immune system of the host. The emergence of immunotherapy has resulted in the successful management of many malignancies. High success rates with certain advanced cancers have attributed wide importance and relevance to the use of immunotherapy. Although ICPis have gained huge popularity, their use often leads to side effects that can affect almost any system; immune-related adverse events (irAEs). These adverse events occur due to unrestrained T cell activity that unsettles the immune homeostasis of the host. Although close monitoring for toxicities controls the events on most of the occasions, the inability to diagnose them early may prove fatal on some occasions due to their subtle and nonspecific symptoms. This review summarizes in brief the usual irAEs and their management, besides a very important nursing perspective, from a nursing expert about an overall insight into the routine irAEs.

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Endocrine toxicity of cancer immunotherapy: clinical challenges

Cited by 16 publications

References 79 publications

Autoimmune Complications in Hematologic Neoplasms

Autoimmune Complications in Hematologic Neoplasms

Grading Central Diabetes Insipidus Induced by Immune Checkpoint Inhibitors: A Challenging Task

Immune-Related Adverse Events (irAEs) in Cancer, with Inputs from a Nursing Expert: A Review

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