ANTICANCER IMMUNOTHERAPY AND RELATED ENDOCRINE ADVERSE EVENTS
- Giusy Elia, Italy
Abstract
Background and Aims
New therapeutic approaches based on immune checkpoint inhibitor (ICI), that headed to unleash the immune system against cancer, have been recently investigated. Patients with melanoma, non-small-cell lung, bladder, renal, cervical, urotherial, and colorectal cancers, Merkel cell carcinoma, and Hodgkin lymphoma, showed notable improvements with ICI treatments. Monoclonal antibodies (mAbs) act on immune checkpoints, such as anti-CTLA-4 ( ipilimumab), anti-PD-1 (nivolumab, pembrolizumab), anti-PD-L1 (durvalumab, atezolizumab, avelumab), making the immune system able to react against tumor cells. ICIs are associated with immune-related adverse events (irAEs) that are clinically and pathophysiologically different from those caused by chemotherapies.
Methods
We have searched on Pubmed about ICI therapies and related endocrine adverse events.
Results
The most frequent endocrine irAEs related to anti-PD-1 mAb treatment are thyroid dysfunctions, whereas hypophysitis is mostly associated to anti-CTLA-4 treatment. Type 1 diabetes mellitus and adrenalitis are rare irAEs. The combination of anti-CTLA-4 plus anti-PD-1/PD-L1 therapies could be lead to an increased risk and prevalence of endocrine irAEs.
Conclusions
A tight collaboration among oncologists, endocrinologists and immunologists appears necessary when the circumstances are more challenging and for a better management of severe endocrine irAEs. More investigations are needed to better understand the mechanisms by which different ICIs can induce a variety of endocrine irAEs.