Introduction: Immune checkpoint inhibitors such as CTLA 4 inhibitors (Ipilimumab) and PD1 inhibitors (Nivolumab/ Pembrolizumab) are being increasingly used for treatment of malignant melanomas and other solid tumours. Despite clinical benefits, they have been known to cause certain Immune related adverse effects (IrAEs) which may be dermatological, gastrointestinal, endocrine, or other immune phenomenon.
The endocrine side effects with checkpoint inhibition include hypophysitis, thyroid and adrenal dysfunction. However, there are currently no established monitoring guidelines.
Audit: Our aim was to check the monitoring of endocrine dysfunction in all patients undergoing treatment, and possibly devise guidelines for monitoring these patients long term.
We retrospectively reviewed all patients who received immune check point inhibitors either as single agents or in combination from 2013 to 2017 using the following standards for analysis (these standards were devised after discussion with Endocrine and Oncology consultants)
1. Baseline cortisol and thyroid stimulating hormone (TSH) to be checked for all patients prior to treatment.
2. Checking TSH and cortisol every cycle / monthly from the point of initiation of treatment up to 3 months after completion for all patients.
Data sources included outpatient clinic letters, electronic prescriptions, biochemistry results and multidisciplinary team meeting summaries. Analysis of quantitative data was in percentages and proportions.
Results and Conculusion: 17% of patients developed endocrine dysfunction and there was inconsistent monitoring of endocrine function. This supports the need for a monitoring protocol for all patients starting immunotherapy to assess for endocrine dysfunction, as they could be potentially life threatening.