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Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management of immune checkpoint inhibitor endocrinopathies and the role of advanced practice providers in the management of immune-mediated toxicities

Supportive Care in Cancer volume 28, pages 6175–6181 (2020)Cite this article

Abstract

Immune checkpoint inhibitors (ICIs) have emerged as the newest pillar of cancer treatment, transforming outcomes in melanoma and showing benefit in a range of malignancies. Immune-mediated toxicities, stemming from increased activity within the T cell lineage, range from asymptomatic or mild complications to those that are fulminant and potentially fatal. Immune-mediated endocrinopathies include hypophysitis, thyroiditis, and insulin-dependent diabetes mellitus. These presentations, which may be vague and non-specific, can be life-threatening if not diagnosed and treated appropriately. This review considers the work-up and management of immune-mediated endocrinopathies and also considers the role of advanced practice practitioners in the management of immune-mediated toxicities. These state-of-the-art MASCC recommendations represent a comprehensive overview of the management and clinical work-up in those in whom the diagnosis should be considered.

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Funding

Professor BL Rapoport is supported by the Cancer Association of South Africa (CANSA) and the National Research Foundation (NRF) of South Africa.

Dr. I. Glezerman is supported by the NIH/NCI (Cancer Center Support Grant P30 CA008748)

Author information

Authors and Affiliations

  1. The Christie and Manchester University Foundation Trust, Manchester, UK

    Tim Cooksley

  2. Department of Medicine, Endocrine Division, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Monica Girotra

  3. Weill Cornell Medical College, New York, NY, USA

    Monica Girotra

  4. Oncology Nursing Society, Pittsburgh, PA, USA

    Pamela Ginex

  5. Clinical Trials, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Ruth Ann Gordon

  6. Department of Immunology, Faculty of Health Sciences, University or Pretoria, Corner Doctor Savage Road and Bophelo Road, Pretoria, 0002, South Africa

    Ronald Anderson & Bernardo L. Rapoport

  7. Laboratory of Immunopathology, Institute of Biology and Experimental Medicine-CONICET, Buenos Aires, Argentina

    Ada Blidner

  8. Division of Oncodermatology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Jennifer Choi

  9. Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Michael Dougan

  10. Renal Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Ilya Glezerman

  11. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Dipti Gupta

  12. Department of Medicine, Vanderbilt University Medical Center and Vanderbilt Ingram Cancer Center, Nashville, TN, USA

    Douglas Johnson

  13. Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Vickie R. Shannon

  14. Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Maria Suarez-Almazor

  15. The Medical Oncology Centre of Rosebank, 129 Oxford Road, Saxonwold, 2196, Johannesburg, South Africa

    Bernardo L. Rapoport

Authors
  1. Tim Cooksley
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  2. Monica Girotra
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  7. Jennifer Choi
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  14. Bernardo L. Rapoport
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Contributions

All of the authors contributed equally to the conceptualization of the manuscript; TC, MG, PG, and RG shared sections on endocrinopathies and the role of advanced practice providers, while BLR, TC, MG, and DBJ provided clinical input and BLR, DBJ, TC, and RA editorial oversight. All of the authors provided critical appraisal of the manuscript and approve of its submission.

Corresponding author

Correspondence to Bernardo L. Rapoport.

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Conflict of interest

AB, RA, JC, TC, PG, DG, RAG, and VRS have no conflict of interest to declare. MD reports grants from Novartis, other (SAB) from Neoleukin Therapeutics, personal fees from Partner Therapeutics, personal fees from Tillotts Pharma, and grants from Genentech, outside the submitted work. MG reports consultant work with Bristol Myers Squibb (BMS) and AstraZeneca, outside the submitted work. IG reports other (Stock Ownership) from Pfizer Inc. and personal fees from CytomX Inc, outside the submitted work. DBJ reports other (advisory board) from Array Biopharma, grants and other (advisory board) from BMS, other (advisory board) from Jansen, grants from Incyte, other (advisory board) from Merck, and other (advisory board) from Novartis, outside the submitted work. BLR reports personal fees and other (advisory board) from Merck and Co; grants, personal fees, and other (advisory board) from BMS; grants, personal fees, and other (advisory board) from Roche South Africa; and personal fees and other (advisory board) from AstraZeneca, during the conduct of the study. MSA reports personal fees from Gilead, grants from Pfizer, and personal fees from Abbvie, outside the submitted work.

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Tim Cooksley and Monica Girotra are joint first authors.

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Cooksley, T., Girotra, M., Ginex, P. et al. Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management of immune checkpoint inhibitor endocrinopathies and the role of advanced practice providers in the management of immune-mediated toxicities. Support Care Cancer 28, 6175–6181 (2020). https://doi.org/10.1007/s00520-020-05709-1

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Keywords

  • APPs (advanced practice providers)
  • Corticosteroids
  • Diabetes
  • Hyperglycemia
  • Hypophysitis
  • Thyroiditis