Development of three endocrinopathies under nivolumab therapy

Abstract

Active implementation of immune checkpoint inhibitors into oncology practice leads to an increase in numbers of observed immune-mediated adverse events, including various endocrinopathies. The focus is on multiple endocrine gland involvement because their predictors are unclear. The paper describes a clinical case of a patient with central cancer of the right lung, who had been administered immune therapy with anti-PD-1 monoclonal antibody (nivolumab). Under this treatment, three endocrine immune-mediated adverse events developed without any concomitant problems from other organs and body systems. The most interesting was the occurrence of adrenal insufficiency and fulminant diabetes mellitus, while, unlike hypothyroidism, which also developed in this patient, those two have been significantly less often described and up to now their incidence, prevalence and association with a certain subgroup of immune checkpoint inhibitors have not been identified. Despite multiple endocrine organ involvement and taking into account positive effects of the anti-tumor treatment, as well as titration of the corresponding hormonal replacement therapy, treatment with nivolumab was continued. Patients treated with immune checkpoint inhibitors require a multidisciplinary team approach including an endocrinologist, because of the potential multiple endocrinopathies, including life-threatening.

Keywords

• immune checkpoint inhibitors
• nivolumab
• endocrine immune-mediated adverse events
• adrenal insufficiency
• hypothyroidism
• diabetes mellitus
• lung cancer