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Endocrine Toxicities Related to Immunotherapy

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Handbook of Cancer and Immunology

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Abstract

Understanding of the mechanisms by which cancer cells evade T-cell immunity through interaction with a number of ligands has led to the introduction of immunotherapy. Immune checkpoint inhibitors prevent T-cell deactivation by malignant cells enhancing the anticancer immune response. Agents acting on CTLA-4 and PD-1, and its ligand are the principal therapeutic immunotherapy drugs in practice. These agents are potent and are now used in a variety of malignancies. Activation of the immune system results in risk of adverse effects, particularly affecting the skin, GI tract, and endocrine system. This review addresses the endocrine toxicities seen with immunotherapy. Thyroid, pituitary, and adrenal diseases are most common. Diabetes, as a result of islet-cell destruction, also occurs as do rarer endocrinopathies. Differences in rates and patterns of endocrine complications are seen with the CTLA-4 and PD-1 acting agents. This chapter summarizes the endocrine consequences of immunotherapy and provides guidance on the management of these common conditions.

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Abbreviations

Ab:

Antibody

ACTH:

Adrenocorticotropic hormone

ADH:

Antidiuretic hormone

APS:

Autoimmune polyendocrine syndrome

BMI:

Body mass index

CaSR:

Calcium sensing receptor

CD8:

Cluster of differentiation 8

CT:

Computed tomography

CTCAE:

Cancer Institute Common Terminology Criteria for Adverse Events

CTLA-4:

Cytotoxic T-lymphocyte antigen 4

DKA:

Diabetic ketoacidosis

DM:

Diabetes mellitus

FDG-PET:

Fluorodeoxyglucose positron emission tomography

FSH:

Follicle-stimulating hormone

GAD:

Glutamic acid decarboxylase

GLP1:

Glucagon-like peptide-1

ICI:

Immune checkpoint inhibitor

IFNɤ:

Interferon gamma

IGF-1:

Insulin-like growth factor-1

IgG:

Immunoglobulin G

IL10:

Interleukin 10

IL2:

Interleukin 2

iRAE:

Immune-related adverse event

IV:

Intravenous

LH:

Luteinizing hormone

MDI:

Multiple daily injections

MRI:

Magnetic resonance imaging

PAI:

Primary adrenal insufficiency

PD-1:

Programmed cell death protein 1

PD-L1:

Programmed cell death protein ligand 1

PTH:

Parathyroid hormone

SUV:

Standardized uptake value

TDS:

Ter die sumendum (to be taken three times daily)

TGB:

Thyroglobulin

TKI:

Tyrosine kinase inhibitor

TME:

Tumor microenvironment

TPO:

Thyroid peroxidase

TSH:

Thyroid-stimulating hormone

TSI:

Thyroid-stimulating immunoglobulin

USS:

Ultrasound scan

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Authors and Affiliations

  1. Department of Endocrinology, Guys and St Thomas Hospitals NHS Foundation Trust, London, UK

    M. Quinn, P. V. Carroll & M. N. Joshi

Authors
  1. M. Quinn
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  2. P. V. Carroll
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  3. M. N. Joshi
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Correspondence to M. N. Joshi .

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Editors and Affiliations

  1. Division of Clinical Immunology, Karolinska University Hospital, Huddinge, Sweden

    Nima Rezaei

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Quinn, M., Carroll, P.V., Joshi, M.N. (2022). Endocrine Toxicities Related to Immunotherapy. In: Rezaei, N. (eds) Handbook of Cancer and Immunology. Springer, Cham. https://doi.org/10.1007/978-3-030-80962-1_348-1

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  • DOI: https://doi.org/10.1007/978-3-030-80962-1_348-1

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