How we treat endocrine complications of immune checkpoint inhibitors

Paschou, Stavroula Α.; Stefanaki, Katerina; Ψαλτοπούλου, Θεοδώρα; Liontos, Michael; Koutsoukos, Konstantinos; Zagouri, Flora; Lambrinoudaki, Ιrene; Dimopoulos, Meletios-Athanasios

doi:10.1016/j.esmoop.2020.100011

Cited by 42 publications

(97 citation statements)

References 69 publications

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“…Therefore, it is mandatory to start the treatment promptly, even in the absence of confirmatory testing or subtype classification (Figure 1) [46]. As for SAI due to hypopituitarism, the therapy of PAI requires glucocorticoid replacement and might include mineralocorticoid supplementation [21,35,46,[49][50][51][52][53][54][55]. As ICI-induced PAI is not a common irAE and may be vague in its clinical presentation; close monitoring of patients is necessary due to the risk of adrenal crisis.…”

Section: Tki-induced Adrenal Insufficiencymentioning

confidence: 99%

“…As ICI-induced PAI is not a common irAE and may be vague in its clinical presentation; close monitoring of patients is necessary due to the risk of adrenal crisis. In general, patients diagnosed with ICI-induced PAI can continue their ICI therapy after recovering from acute symptoms and dysfunctions, as in cases of ICI-induced hypophysitis (Figure 2) [35,[49][50][51][52][53][54][55].…”

Section: Tki-induced Adrenal Insufficiencymentioning

confidence: 99%

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Endocrine Toxicities of Antineoplastic Therapy: The Adrenal Topic

Barnabei

Senes

Scoppola

et al. 2022

Cancers

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Immune checkpoint inhibitors (ICIs) have improved survival in patients affected by several solid tumours at the cost of new autoimmune adverse events. Endocrine toxicity is frequently reported in patients treated with these agents, mainly as thyroid dysfunction and hypophysitis. Primary adrenal insufficiency is reported in 1–2% of patients receiving a single ICI, but its rate is approximately 5% in patients treated with a combination of two ICIs. The clinical presentation of adrenal insufficiency may be insidious due to symptoms that are not specific. The same symptoms in cancer patients are frequently multifactorial, rendering the early diagnosis of adrenal insufficiency challenging in this group of patients. As adrenal insufficiency can be fatal if not rapidly diagnosed and treated, oncologists should be aware of its clinical presentations to timely involve endocrinologists to offer patients the appropriate management. In parallel, it is essential to educate patients, their caregivers, and relatives, providing them with detailed information about the risk of adrenal insufficiency and how to manage alarming symptoms at their onset. Finally, large collaborative trials are needed to develop appropriate tests to assess better the personal risk of drug-induced adrenal insufficiency and its early diagnosis and treatment, not only in cancer patients.

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Section: Tki-induced Adrenal Insufficiencymentioning

confidence: 99%

Section: Tki-induced Adrenal Insufficiencymentioning

confidence: 99%

Endocrine Toxicities of Antineoplastic Therapy: The Adrenal Topic

Barnabei

Senes

Scoppola

et al. 2022

Cancers

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“…Gonadal function can be replaced in selected patients depending on age and prognosis, whereas growth hormone treatment is generally contraindicated. Highdose glucocorticoid therapy is only reserved for patients suffering from mass effects (compression of the optic chiasma) or severe headache, but should not be routinely used [9,10,18]. Of note, normally pituitary hormone deficiency does not recover; therefore, it is essential to educate patients and their families in dose adaptations of glucocorticoid replacement in case of stressful situations or acute medical events (sick day rules).…”

Section: Hypophysitismentioning

confidence: 99%

“…Most cases have been reported following PD-1 directed treatment [1]. It is characterized by an acute onset, which results from a rapid insulin deficiency with a high risk of diabetic ketoacidosis [18]. Due to the fulminant onset, Hba1c is usually not helpful in establishing the diagnosis.…”

Section: Rare Endocrine Adverse Eventsmentioning

confidence: 99%

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Clinical challenges in the management of endocrine side effects of immuno-oncological therapies

Wolf

Scherer

2021

memo

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SummaryGiven the growing use of immune checkpoint inhibitor (ICI) therapy in oncology, the prevalence of endocrine side effects is rapidly increasing. As clinicians are nowadays frequently confronted with these side effects in routine clinical care, awareness, better knowledge of endocrine irAEs and their clinical presentation and diagnosis is crucial for an adequate management. In this short-review we give a compact overview of the recent recommendations for the management of endocrine irAE related to ICIs and highlight difficulties and uncertainties in current clinical practice.

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Endocrine Consequences Following Immune Checkpoint Inhibitors Therapy

Lavrentaki

Ntali

2023

Handbook of Cancer and Immunology

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How we treat endocrine complications of immune checkpoint inhibitors

Cited by 42 publications

References 69 publications

Endocrine Toxicities of Antineoplastic Therapy: The Adrenal Topic

Endocrine Toxicities of Antineoplastic Therapy: The Adrenal Topic

Clinical challenges in the management of endocrine side effects of immuno-oncological therapies

Endocrine Consequences Following Immune Checkpoint Inhibitors Therapy

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