SOCIETY FOR ENDOCRINOLOGY ENDOCRINE EMERGENCY GUIDANCE: Acute management of the endocrine complications of checkpoint inhibitor therapy
Immunotherapy treatment with checkpoint inhibitors (CPI) (CTLA-4 and PD-1 inhibitors) significantly improves survival in a number of cancers. Treatment can be limited by immune-mediated adverse effects including endocrinopathies such as hypophysitis, adrenalitis, thyroiditis and diabetes mellitus. I...
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| Vydané v: | Endocrine Connections Ročník 7; číslo 7; s. G1 - G7 |
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| Hlavní autori: | , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
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England
Bioscientifica Ltd
01.07.2018
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| ISSN: | 2049-3614, 2049-3614 |
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| Abstract | Immunotherapy treatment with checkpoint inhibitors (CPI) (CTLA-4 and PD-1 inhibitors) significantly improves survival in a number of cancers. Treatment can be limited by immune-mediated adverse effects including endocrinopathies such as hypophysitis, adrenalitis, thyroiditis and diabetes mellitus. If endocrinopathies (particularly hypocortisolemia) are not recognized early, they can be fatal. The diagnosis and management of endocrinopathies can be complicated by simultaneous multi-organ immune adverse effects. Here, we present Endocrine Emergency Guidance for the acute management of the endocrine complications of checkpoint inhibitor therapy, the first specialty-specific guidance with Endocrinology, Oncology and Acute Medicine input and endorsed by the Society for Endocrinology Clinical Committee. We present algorithms for management: endocrine assessment and management of patients in the first 24 hours who present life-threateningly unwell (CTCAE grade 3–4) and the appropriate management of mild-moderately unwell patients (CTCAE grade 1–2) presenting with features compatible with an endocrinopathy. Other important considerations in relation to hypohysitis and the maintenance of glucocorticoid therapy are discussed. |
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| AbstractList | Immunotherapy treatment with checkpoint inhibitors (CPI) (CTLA-4 and PD-1 inhibitors) significantly improves survival in a number of cancers. Treatment can be limited by immune-mediated adverse effects including endocrinopathies such as hypophysitis, adrenalitis, thyroiditis and diabetes mellitus. If endocrinopathies (particularly hypocortisolemia) are not recognized early, they can be fatal. The diagnosis and management of endocrinopathies can be complicated by simultaneous multi-organ immune adverse effects. Here, we present Endocrine Emergency Guidance for the acute management of the endocrine complications of checkpoint inhibitor therapy, the first specialty-specific guidance with Endocrinology, Oncology and Acute Medicine input and endorsed by the Society for Endocrinology Clinical Committee. We present algorithms for management: endocrine assessment and management of patients in the first 24 hours who present life-threateningly unwell (CTCAE grade 3–4) and the appropriate management of mild-moderately unwell patients (CTCAE grade 1–2) presenting with features compatible with an endocrinopathy. Other important considerations in relation to hypohysitis and the maintenance of glucocorticoid therapy are discussed. Immunotherapy treatment with checkpoint inhibitors (CPI) (CTLA-4 and PD-1 inhibitors) significantly improves survival in a number of cancers. Treatment can be limited by immune-mediated adverse effects including endocrinopathies such as hypophysitis, adrenalitis, thyroiditis and diabetes mellitus. If endocrinopathies (particularly hypocortisolemia) are not recognized early, they can be fatal. The diagnosis and management of endocrinopathies can be complicated by simultaneous multi-organ immune adverse effects. Here, we present Endocrine Emergency Guidance for the acute management of the endocrine complications of checkpoint inhibitor therapy, the first specialty-specific guidance with Endocrinology, Oncology and Acute Medicine input and endorsed by the Society for Endocrinology Clinical Committee. We present algorithms for management: endocrine assessment and management of patients in the first 24 hours who present life-threateningly unwell (CTCAE grade 3-4) and the appropriate management of mild-moderately unwell patients (CTCAE grade 1-2) presenting with features compatible with an endocrinopathy. Other important considerations in relation to hypohysitis and the maintenance of glucocorticoid therapy are discussed.Immunotherapy treatment with checkpoint inhibitors (CPI) (CTLA-4 and PD-1 inhibitors) significantly improves survival in a number of cancers. Treatment can be limited by immune-mediated adverse effects including endocrinopathies such as hypophysitis, adrenalitis, thyroiditis and diabetes mellitus. If endocrinopathies (particularly hypocortisolemia) are not recognized early, they can be fatal. The diagnosis and management of endocrinopathies can be complicated by simultaneous multi-organ immune adverse effects. Here, we present Endocrine Emergency Guidance for the acute management of the endocrine complications of checkpoint inhibitor therapy, the first specialty-specific guidance with Endocrinology, Oncology and Acute Medicine input and endorsed by the Society for Endocrinology Clinical Committee. We present algorithms for management: endocrine assessment and management of patients in the first 24 hours who present life-threateningly unwell (CTCAE grade 3-4) and the appropriate management of mild-moderately unwell patients (CTCAE grade 1-2) presenting with features compatible with an endocrinopathy. Other important considerations in relation to hypohysitis and the maintenance of glucocorticoid therapy are discussed. |
| Author | Cooksley, T Trainer, P J Olsson-Brown, A Morganstein, D Lorigan, P Larkin, J Higham, C E Carroll, P |
| AuthorAffiliation | The University of Liverpool, Brownlow Hill, Liverpool, UK Department of Acute Medicine, UHSM and Christie Hospital NHS Foundation Trust, Manchester, UK The Clatterbridge Cancer Centre, Bebbington, Wirral, UK Department of Medical Oncology, Christie Hospital NHS Foundation Trust, Manchester, UK Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK Skin Unit, Royal Marsden Hospital, London, UK Department of Endocrinology, Guy’s & St. Thomas’ NHS Foundation Trust, London, UK Department of Endocrinology, Chelsea and Westminster Hospital, London, UK The Society for Endocrinology, Starling House, 1600 Bristol Parkway North, Bristol, UK |
| AuthorAffiliation_xml | – name: Department of Endocrinology, Guy’s & St. Thomas’ NHS Foundation Trust, London, UK – name: Department of Medical Oncology, Christie Hospital NHS Foundation Trust, Manchester, UK – name: Skin Unit, Royal Marsden Hospital, London, UK – name: Department of Endocrinology, Chelsea and Westminster Hospital, London, UK – name: Department of Acute Medicine, UHSM and Christie Hospital NHS Foundation Trust, Manchester, UK – name: The Clatterbridge Cancer Centre, Bebbington, Wirral, UK – name: Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK – name: The Society for Endocrinology, Starling House, 1600 Bristol Parkway North, Bristol, UK – name: The University of Liverpool, Brownlow Hill, Liverpool, UK |
| Author_xml | – sequence: 1 givenname: C E surname: Higham fullname: Higham, C E email: claire.higham@christie.nhs.uk organization: Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK – sequence: 2 givenname: A surname: Olsson-Brown fullname: Olsson-Brown, A organization: The University of Liverpool, Brownlow Hill, Liverpool, UK – sequence: 3 givenname: P surname: Carroll fullname: Carroll, P organization: Department of Endocrinology, Guy’s & St. Thomas’ NHS Foundation Trust, London, UK – sequence: 4 givenname: T surname: Cooksley fullname: Cooksley, T organization: Department of Acute Medicine, UHSM and Christie Hospital NHS Foundation Trust, Manchester, UK – sequence: 5 givenname: J surname: Larkin fullname: Larkin, J organization: Skin Unit, Royal Marsden Hospital, London, UK – sequence: 6 givenname: P surname: Lorigan fullname: Lorigan, P organization: Department of Medical Oncology, Christie Hospital NHS Foundation Trust, Manchester, UK – sequence: 7 givenname: D surname: Morganstein fullname: Morganstein, D organization: Department of Endocrinology, Chelsea and Westminster Hospital, London, UK – sequence: 8 givenname: P J surname: Trainer fullname: Trainer, P J organization: Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/29930025$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1097/RLU.0000000000000887 10.1530/EC-16-0058 10.1056/NEJMoa1411087 10.1158/1078-0432.CCR-14-2353 10.1007/s11102-009-0193-z 10.1210/jc.2014-4560 10.1093/annonc/mdv623 10.1089/thy.2016.0229 10.1016/j.ctrv.2016.02.001 10.2337/dc15-1331 10.1530/EJE-10-0833 10.1056/NEJMoa1504030 10.1093/annonc/mdv383 10.1016/S2213-8587(13)70031-7 10.1210/jc.2014-2306 10.1186/s40425-017-0213-x 20153810.2337/dc14-2349 10.1530/EC-16-0054 10.1056/NEJMoa1003466 |
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| Snippet | Immunotherapy treatment with checkpoint inhibitors (CPI) (CTLA-4 and PD-1 inhibitors) significantly improves survival in a number of cancers. Treatment can be... |
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| Title | SOCIETY FOR ENDOCRINOLOGY ENDOCRINE EMERGENCY GUIDANCE: Acute management of the endocrine complications of checkpoint inhibitor therapy |
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