Endocrine toxicity of immune checkpoint inhibitors: essential crosstalk between endocrinologists and oncologists

Abstract

Two types of immune checkpoint inhibitors, both antibodies that target cytotoxic T-lymphocyte antigen-4 and those that target programmed cell death-protein 1, have been approved for use in melanoma, non-small-cell lung cancer, and renal cell carcinoma as first-line or second-line therapy. Their adverse events are primarily regarded as immune-related adverse events. We felt it was important to pinpoint and discuss certain preconceptions or misconceptions regarding thyroid dysfunction, hypophysitis, and diabetes induced by immune checkpoint inhibitors. We have identified areas of uncertainty and unmet requirements, including essential interaction between endocrinologists and oncologists. Five issues have been identified for discussion: (1) diagnosis of endocrine toxicity, (2) assessment of toxicity severity, (3) treatment of toxicity, (4) withdrawal or continuation of immunotherapy, (5) preventive action.

Thumbnail image of graphical abstract

The rational data on endocrine toxicity of immune checkpoint inhibitors are scarce. It seemed important to us to indicate and discuss some pre- or misconceptions about thyroid dysfunction, hypophysitis, and diabetes induced by immune checkpoint inhibitors, in order to improve the management of patients.

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