Medizinische Universität Graz - Research portal
Selected Publication:
Lang, A.
Endocrine adverse events of Immune Checkpoint Inhibitors: Case Report and Literature Research
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2019. pp. 66
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- Authors Med Uni Graz:
- Advisor:
- Pilz Stefan
- Trummer Christian
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- Abstract:
- Immune checkpoint inhibitors (ICI) are relatively new and highly efficient drugs in cancer therapy. Their range of indication is currently mainly limited to patients with progressive cancer after chemotherapy but the indication spectrum is expanding these days. Responding rates vary from about 20-40%. Apart from their excellent efficacy, it should be mentioned that they can also cause so-called “immune-related adverse events” (irAEs). The pathophysiological mechanisms of their beneficial actions and side effects are complex and not yet fully understood. Therefore, the aim of this thesis is to give an overview of immunological actions of immune checkpoint inhibitors with a focus on T cell function and modulating mechanisms of the immune system. Furthermore, the current literature is reviewed regarding the efficacy of these agents and potential reasons for unresponsiveness. Furthermore, an overview of the incidence and characteristics of immune-related adverse events is provided. In this context, the differences of the available checkpoint inhibitors with regard to effects and adverse events are outlined and discussed. With reference to the immune-related side effects, a special focus is laid on adverse events affecting the endocrine organs, in particular hypophysitis, as this disease potentially can be life-threatening. Other common endocrine adverse events are thyroid disorders which are described with different incidences across the literature. However, hypothyroidism is widely presented as the most frequent condition. Rare endocrine adverse events like primary adrenal insufficiency and insulin dependent diabetes mellitus are also discussed. Additionally, current guidelines regarding management of endocrine side effects as well as a comparison with management of non-endocrine side effects are provided. Lastly and to give some insights into clinical routine, three case reports from patients experiencing immune-related adverse events are presented.