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oregon; portland; ppmc
Internal Medicine | Oncology
INTRODUCTION: Emergence of cancer immunotherapy has instigated a new era in field of oncology and revolutionized treatment of cancer. In 2011, Immune Checkpoint Inhibitors (ICI) gained approval for treatment of advanced solid and hematological malignancies and have had remarkable results. Since being released, new cases of irreversible endocrine adverse events are increasingly becoming reported and leave patients with a new life-long diagnosis after battling metastatic cancer.
Discussion • 6 Immune Checkpoint Inhibitors (ICIs) approved: •CTLA-4 (cytotoxic T-lymphocyte-associated protein 4) inhibitor Ipilimumab •PD-1 (programmed cell death protein 1) inhibitors nivolumab, pembrolizumab •PD-L1 (programmed cell death ligand 1) inhibitors atezolizumab, avelumab, durvalumab •T-cell surface receptors immunological tolerance to self-antigens, prevent autoimmune disorders •Endocrine dysfunction –most common adverse effect •Hypothyroidism, hyperthyroidism, hypophysitis, primary adrenal insufficiency, insulin-deficient diabetes •Higher with combination therapy •Thyroid dysfunction most common •Life-threatening thyroid storm: anti-PD1 agents •Destructive thyroiditis by cytotoxic cells against thyroid gland (thyroid gland expresses both PD-L1, PD-L2 molecules) •Hypophysitismost common with ipilimumab(CTLA-4 protein expressed in pituitary glands) •Primary adrenal insufficiency –very rare (0.7%) •Insulin-dependent diabetes: with anti-PD1 therapy and Ipilimumab •Current guidelines recommend baseline screening with TFTs, morning cortisol and ACTH and screening monthly thereafter.
Graduate Medical Education
Conference / Event Name
Academic Achievement Day, 2021
Providence Portland Medical Center
Petrenko, Olesya and Stucky, Nicholas L, "Double the Battle: Two Cases of Irreversible Endocrinopathies in Patients Already Fighting Metastatic Cancer." (2021). Providence Portland Medical Center Internal Medicine 2021. 8.