Endocrine Abstracts

Immune-checkpoint inhibitors have become important elements of oncology therapy in recent years. These monoclonal antibodies block immune-checkpoints, unleashing T cells to fight cancer. However, immune-checkpoints also play an important role in the prevention of autoimmune processes and immune-checkpoint inhibitor therapy can also trigger autoimmune adverse effects, termed immune-related adverse events. Endocrinopathies are among the most common immune-related side effects.

Objectives and methods: We analysed data of 221 patients (131 males, 90 females, age 61.4±13.3 years) retrospectively, who received immune-checkpoint inhibitor therapy for malignant melanoma at the Department of Dermatology since 2015 and we investigated endocrine side effects in these patients. Based on the obtained data, our aim was to develop a diagnostic guideline that can help to recognize endocrine side effects that develop during immune-checkpoint inhibitor therapy as soon as possible and to treat them appropriately.

Results: Endocrine side effects occurred in 69 cases (31.2% of the patients). 58% of these patients were men, 42% were women and the average age was 61.4±12.8 years. In 25% of the patients, the side effect appeared within one month after starting treatment, and in 89.1% within one year. 83.8% of endocrine side effects affected the thyroid gland, 16.2% isolated the pituitary gland, and 7.4% had side effects in both the thyroid and pituitary gland. We detected central hypadrenia in all patients diagnosed with hypophysitis. 36.2% of patients needed treatment due to endocrinopathy; discontinuation of immune-checkpoint inhibitor therapy due to an endocrine side effect was not necessary in any case.

Conclusions: Endocrine side effects occurred in almost 1/3 of the patients receiving immune checkpoint inhibitor therapy. Based on the results of our study, endocrinopathies occur in a similar proportion in men and women, which means a difference compared to the female dominance observed typically in autoimmune thyroid diseases and autoimmune hypophysitis. Endocrine side effects occurred in 25% of cases after one month of immune-checkpoint therapy, this result highlight the need for screening in time in order to achieve timely diagnosis and administer appropriate treatment. It is particularly important to recognize hypophysitis, which can cause a life-threatening crisis in the case of untreated central hypadrenia.