French Endocrine Society guidance on endocrine side effects of immunotherapy
Open accessAbstract
The management of cancer patients has changed due to the considerably more frequent use of immune checkpoint inhibitors (ICPIs). However, the use of ICPI has a risk of side effects, particularly endocrine toxicity. Since the indications for ICPI are constantly expanding due to their efficacy, it is important that endocrinologists and oncologists know how to look for this type of toxicity and how to treat it when it arises. In view of this, the French Endocrine Society initiated the formulation of a consensus document on ICPI-related endocrine toxicity. In this paper, we will introduce data on the general pathophysiology of endocrine toxicity, and we will then outline expert opinion focusing primarily on methods for screening, management and monitoring for endocrine side effects in patients treated by ICPI. We will then look in turn at endocrinopathies that are induced by ICPI including dysthyroidism, hypophysitis, primary adrenal insufficiency and fulminant diabetes. In each chapter, expert opinion will be given on the diagnosis, management and monitoring for each complication. These expert opinions will also discuss the methodology for categorizing these side effects in oncology using 'common terminology criteria for adverse events' (CTCAE) and the difficulties in applying this to endocrine side effects in the case of these anti-cancer therapies. This is shown in particular by certain recommendations that are used for other side effects (high-dose corticosteroids, contraindicated in ICPI for example) and that cannot be considered as appropriate in the management of endocrine toxicity, as it usually does not require ICPI withdrawal or high-dose glucocorticoid intake.
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Adrenal insufficiency has been reported with nivolumab, pembrolizumab, and ipilimumab.
“Among the different ICIs, AI has been reported on treatment with nivolumab, pembrolizumab, and ipilimumab (30)”
From The Changing Face of Drug-induced Adrenal Insufficiency in the Food and Drug Administration Adverse Event Reporting System (2022) · cites this paper as [30]
ACTH deficiency in secondary adrenal insufficiency was reported to persist in 86% to 100% of patients, leading to the need for chronic hormone replacement therapy.
“ACTH deficiency was reported to persist in 86%-100% of patients, leading to the need for chronic hormone replacement therapy (30).”
From The Changing Face of Drug-induced Adrenal Insufficiency in the Food and Drug Administration Adverse Event Reporting System (2022) · cites this paper as [30]
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Immunotherapy-Related Hypophysitis: A Narrative Review
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Stress Axis in the Cancer Patient: Clinical Aspects and Management
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Therapeutical Usefulness of PD-1/PD-L1 Inhibitors in Aggressive or Metastatic Pituitary Tumours
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Immune checkpoint inhibitor-related thyroid dysfunction
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Self-citationHypophysites induites par les immunothérapies anti-néoplasiques
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The Price of Success: Immune-Related Adverse Events from Immunotherapy in Lung Cancer
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Steroid treatment in the management of destructive thyrotoxicosis induced by PD1 blockade
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Les limites des inhibiteurs de points de contrôle immunitaire et la gestion de leur toxicité
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Hypoparathyroidism: an uncommon adverse effect of treatment with durvalumab
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Principaux troubles hydro-électrolytiques chez le patient de cancérologie
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Management of Thyrotoxicosis Induced by PD1 or PD-L1 Blockade
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Thyroïdites : où en est-on en 2019 ?
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An Update on Immune Checkpoint Inhibitor-related Hypophysitis
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Hypophysitis Associated with Immune Checkpoint Inhibitors
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- Authors
- Castinetti, F., Albarel, F., Archambeaud, F., Bertherat, J., Bouillet, B., Buffier, P., Briet, C., Cariou, B., Caron, P., Chabre, O., Chanson, P., Cortet, C., Do Cao, C., Drui, D., Haissaguerre, M., Hescot, S., Illouz, F., Kuhn, E., Lahlou, N., Merlen, E., Raverot, V, Smati, S., Verges, B., & Borson-Chazot, F.
- Affiliations
- Inserm (FR)
- 2Service de Médecine Interne B – Endocrinologie, Limoges Cedex, France
- Hôpital Cochin (FR)
- CHU Dijon Bourgogne (FR)
- Centre Hospitalier Universitaire de Nantes (FR)
- Centre Hospitalier Universitaire de Toulouse (FR)
- Hôpital Albert Michallon (FR)
- Université Paris-Saclay (FR)
- Centre Hospitalier Universitaire de Lille (FR)
- 11CHRU de Lille – Hopital Huriez, Service d’Endocrinologie, Lille Cedex, France
- 12CHU de Bordeaux – Hôpital du Haut Lévêque, Service d’Endocrinologie-Diabétologie et Maladies Métaboliques, Pessac Cedex, France
- Institut Curie (FR)
- Centre Hospitalier Universitaire d'Angers (FR)
- 15Département d’Hormonologie Spécialisée, BPR-AS, Pannes, France
- Hospices Civils de Lyon (FR)
- 4CHU Dijon, Hôpital François Mitterrand, Service d’Endocrinologie, Diabétologie, Maladies Métaboliques, Dijon Cedex, France
- 17Hospices Civils de Lyon, Fédération d’Endocrinologie, Université Claude Bernard Lyon 1, Lyon, France
- Corresponding author
- Castinetti, F
- ORCID
- Venue
- Endocrine Related Cancer
- Publisher
- Bioscientifica
- Published
- 2019-02
- Volume
- 26
- Issue
- 2
- Pages
- G1-G18
- ISSN
- 1351-0088 (ISSN-L)
- 1479-6821
- PMC
- PMC6347286
- OpenAlex
- W2895782973
- Cited by
- 140
- References
- 91
- Citations by year
- 2026: 4 · 2025: 16 · 2024: 12 · 2023: 22 · 2022: 21 · 2021: 35 · 2020: 20 · 2019: 10
- FWCI
- 6.11
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Endocrine Related Cancer (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- HAL (submittedVersion, cc-by)
- HAL (submittedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Keywords
- immune checkpoint inhibitors, endocrine toxicity, immune-related adverse events, hypophysitis, Addison's disease, fulminant diabetes, thyroid dysfunction, CTCAE, glucocorticoid therapy, cancer immunotherapy
- MeSH terms
- Antineoplastic Agents, Immunological, Endocrine System Diseases, France, Humans, Immunotherapy
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