Endocrine Abstracts

Background: The use of immune checkpoint inhibitors (iCPIs) has significantly increased in the treatment of various malignancies, leading to a rise in immune-related adverse events (irAEs), including endocrine toxicities.

Objective: We aim to identify the prevalence and management of endocrinopathies in cancer patients treated with iCPIs in our centre.

Methods: A retrospective audit of cancer patients who received iCPIs was conducted. 40 cases of each iCPIs group from clinical database (Clinical records, electronic discharge templates and laboratory report) were reviewed. The need for secondary interventions, such as endocrinology consultations, was also analysed.

Results: A total of 160 cases (40% female, treated for 16 different types of cancer) were identified. Number of patients received iCPIs therapy were Pembrolizumab (n = 40), combination Nivolumab and Ipilimumab (40). Atezolizumab (n = 38), Durvalumab (n = 15), Avelumab (n = 20), and Duvalumab (n = 15). Incidence of endocrinopathies were autoimmune hypothyroidism (16.8%), adrenal insufficiency (2.5%), hyperthyroidism (1.25%), hypophysitis (1.25%) and diabetes (1.25%). All patients received monitoring blood tests for thyroid function and cortisol level checked after initiation of iCPIS. The median and mean duration of initiation of iCPIs to the diagnosis endocrinopathy were 144 and 201 days respectively (range 8 - 558). Endocrinopathies dose not linked with a specific type or stage of underlying cancer diagnosis. One patient receiving Pembrolizumab was hospitalized for an adrenal crisis. In patients on Atezolizumab and one case of diabetes ketoacidosis despite frequent monitoring. 7.5% of patients treated with iCPIs required endocrinology follow up.

Conclusion: The audit identified a notable prevalence of iCPIs related endocrinopathies. These toxicities often present with non-specific symptoms, making early detection challenging and may result in emergency hospital admission. Establishing a high index of suspicion and awareness of this link is crucial for wider medical teams. With increasing use of iCPIs, there should be a proper endocrine service provision need to be considered.