Immune Checkpoint Inhibitor-Induced Adrenalitis and Primary Adrenal Insufficiency: Systematic Review and Optimal Management.

Abstract

OBJECTIVE:

Immune checkpoint inhibitors (ICIs) targeting cytotoxic T-lymphocyte antigen 4 or programmed death 1 and its ligand (programmed death ligand 1) have been approved for the treatment of a variety of cancers. However, ICI therapy is associated with a risk of immune-related adverse events. In this study, we reviewed reported cases of adrenalitis and primary adrenal insufficiency (PAI)-rare but lethal endocrine immune-related adverse events-in patients who underwent ICI therapy.

METHODS:

We searched multiple databases (PubMed, Web of Science, Cochrane, and Scopus) up to February 2020 for case reports on adrenalitis and PAI caused by ICIs.

RESULTS:

We identified 15 case reports on ICI-induced adrenalitis and PAI and reviewed their clinical presentation, characteristics, immunologic and imaging features, and treatment. We also developed a screening strategy for PAI in patients treated with ICIs.

CONCLUSION:

Given the morbidity and mortality associated with acute adrenal crisis, physicians-especially endocrinologists and oncologists-should be aware of this particular risk. PAI caused by autoimmune adrenalitis predominantly occurs in patients treated with programmed death 1 inhibitor monotherapy. PAI often coexists with other endocrinopathies and requires mineralocorticoid as well as glucocorticoid replacement. Even after withdrawal of ICIs, PAI can persist and requires lifelong replacement therapy.

• Authors: Yun Shi, Min Shen, Xuqin Zheng, Tao Yang
• Journal: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists (Endocr Pract) Vol. 27 Issue 2 Pg. 165-169 (Feb 2021) ISSN: 1530-891X [Print] United States
• PMID: 33554872 (Publication Type: Journal Article, Review, Systematic Review)
• Copyright: Copyright © 2020 AACE. Published by Elsevier Inc. All rights reserved.

Chemical References

• Antineoplastic Agents, Immunological
• Immune Checkpoint Inhibitors

Topics

• Addison Disease (chemically induced, drug therapy)
• Adrenal Insufficiency (chemically induced)
• Antineoplastic Agents, Immunological (adverse effects)
• Humans
• Immune Checkpoint Inhibitors
• Neoplasms (drug therapy)