Immunotherapy-induced endocrinopathies: assessment, management and monitoring.

Immunotherapy with checkpoint inhibitors has transformed the treatment of cancer, but frequently results in immune-mediated adverse events affecting multiple organs, amongst which endocrine adverse events are frequent. The patterns of endocrine adverse events differ between inhibitors of the CTLA-4 and PD-1/PD-L1 pathways, but most frequently involve the thyroid and pituitary with insulin deficient diabetes also emerging as an important adverse event. These frequently result in long-lasting hormone deficiency requiring replacement. This review explores the mechanism of action of checkpoint inhibitors and details the expected endocrine adverse events and typical presentations. The effect of high-dose glucocorticoids therapy to treat nonendocrine adverse events is also discussed.
Competing Interests: Conflict of interest statement: DM has received speaker and advisory fees from BMS, MSD and Roche. TND has had support to attend educational conferences from AstraZeneca, BMS, Boehringer Ingelheim, Lilly, MSD, Otsuka, Roche, Takeda, and Advisory and Speaker Bureaus from Amgen, AstraZeneca, BMS, Boehringer Ingelheim, Eli-Lilly, MSD, Novartis, Otsuka, Pfizer, Roche, Takeda.
(© The Author(s), 2019.)