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Endocrine complications of immunotherapies: a review

Journal

CLINICAL MEDICINE
Volume 21, Issue 2, Pages E212-E222

Publisher

ROY COLL PHYS LONDON EDITORIAL OFFICE
DOI: 10.7861/clinmed.2020-0827

Keywords

immunotherapy; cancer; endocrine; thyroid; hypophysitis

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The use of immune checkpoint inhibitors in cancer treatment has increased significantly in the past decade, leading to improved survival rates but also resulting in adverse endocrine effects in around 10% of patients. Thyroid disease and hypophysitis are the most commonly encountered, highlighting the importance of patient and clinician education for early recognition and management of these immune-related complications.
Use of immune checkpoint inhibitors in cancer treatment has increased vastly over the past decade, as both single and combination agent therapies. While having a positive impact on survival rates, adverse effects have been noted, with endocrine effects in around 10% of patients. Thyroid disease and hypophysitis are the most commonly encountered, with diabetes mellitus and primary adrenal insufficiency also reported, as well as more rare endocrinopathies. Patient and clinician education to raise awareness of these effects, as well as regular monitoring to enable early recognition, diagnosis and prompt treatment of the immune side effects, are key. In this review, we discuss the aetiology, presentation and management of the endocrine complications of immunotherapies that are relevant to the general physician, as well as highlighting important areas where further research is still needed.

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