Endocrinopathies with Use of Cancer Immunotherapies

Abstract

Background

Immunomodulatory therapies, including CTLA-4 and PD-1 inhibitors, provide a directed attack against cancer cells by preventing T cell deactivation. However, these drugs also prevent the down-regulation of auto-reactive T cells, resulting in immune-related adverse events (IRAEs). Reports show a varied incidence of endocrine IRAEs, ranging from 0-63%.

Objective

To describe the frequency and clinical characteristics of endocrine IRAEs in patients taking cancer immunomodulatory therapies.

Design

Retrospective cohort study.

Patients

388 patients aged ≥18 years who were prescribed ipilimumab, nivolumab, and/or pembrolizumab between 2009-2016 at our institution.

Measurements

Biochemical criteria were used to define endocrine IRAEs, including thyroid, pituitary, pancreas, and adrenal dysfunction, following use of immunomodulatory therapies.

Results

50 endocrine IRAEs occurred in our cohort, corresponding to a rate of 12.9%. The most common endocrine IRAEs were thyroid dysfunction (11.1%), with a lower incidence of pituitary dysfunction (1.8% of patients).

Conclusions

Over 12% of patients receiving ipilimumab, nivolumab, and/or pembrolizumab in our study sample developed an endocrine IRAE. Patients who undergo treatment with immunomodulatory therapies should be monitored for the development of endocrine IRAEs.

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