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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


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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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)

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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.

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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).

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