Endocrine Abstracts

JOINT2643

Introduction: Immune checkpoint inhibitors have revolutionised cancer therapy in recent years and as the use of this increases, we have recognised the side effects of developing endocrinopathies. Common endocrinopathies include thyroid disease and hypophysitis. Thus, a protocol is needed to help monitor endocrine disorders when initiating and during immunotherapy for cancer patients to diagnose and manage these endocrinopathies earlier.

Aim: Quality improvement project (QIP) to establish baseline monitoring test for endocrine disorder when initiating immunotherapy for cancer treatment and implementation of new trust guidelines to help aid this.

Method: Retrospective single-centre study looking at baseline test for monitoring of endocrine disorders in patients started on immunotherapy for cancer treatment. Blood test for endocrine disorder monitoring including cortisol levels, Thyroid Function Tests (TFTs) and HbA1c.

Results: Cycle 1: 22 patients identified on immunotherapies including Anti-PD-1 Pembrolizumab (11patients) and anti-PD-L-1 such as Atezolizumab (7patients) and Durvalumab (4patients). Pembrolizumab had 55%cortisol, 73% TFTs and 18%HbA1c checked. Atezolizumab had 71% cortisol, 29% TFTs and 14%HbA1c checked. Durvalumab had 50% cortisol, TFTs and HbA1c checked. After cycle one of QIP an informative departmental teaching was carried out and we developed local trust guidelines to help recommended endocrine test monitoring. Cycle 2 included 80 patients 20 patients on Pembrolizumab 100% had cortisol and TFTs checked but only 30% HbA1c. 20 patients on Atezolizumab 100% TFTs, 70% cortisol and 50% HbA1c checked. 20 patients on Durvalumab 100% TFT, 60% cortisol and 50% HbA1c checked. 20 patients on Nivolumab 100% TFTs, 60% cortisol and 60% HbA1c checked.

Conclusion: The use of immunotherapies in cancer treatment has increased. PD-1 inhibitors are commonly associated with thyroid abnormalities (5-10%) and can occur 4-10weeks after initiation of treatment. Diabetes Mellitus (DM) incidence of 1% including new-onset type1 DM or worsening type2 DM. CTLA-4 inhibitors are commonly associated with hypophysitis (3-6%) and usually present in 8-10weeks of initiation of treatment. Our QIP showed in the first cycle more information and awareness were needed for patients and clinicians on complications of developing endocrinopathies and the need of monitoring this. Repeat cycle showed increase in baseline endocrine blood test when initiating immunotherapy with TFTs at 100% tested. Our team developed local trust guidelines for baseline endocrine monitoring for patients on immunotherapy treatment. We plan to repeat our study in 6months time with a larger sample size and looking at 3months monitoring of endocrine blood test to see if any patients developed endocrinopathy complications.