ROME (ITALPRESS) – Two new outpatient clinics in collaboration between endocrinology, oncology, and gynecologic oncology (Endocrinology Outpatient Clinic for Oncologic Complications and Endocrinology Outpatient Clinic for Endocrinologic Complications in Women’s Cancers) are opening at Gemelli to manage endocrinologic complications of immunotherapy. Immunotherapy has revolutionized the treatment of cancer, and also from the latest congress of the European Society of Clinical Oncology (ESMO) come many confirmations about the successes of using these drugs in different types of malignancies. And in the field of melanoma we are even ‘celebrating’ the ten-year milestone of many metastatic patients, who survived a poor prognosis precisely thanks to immunotherapy.These drugs free the immune system from the ‘chains’ imposed by the tumor that prevents it from reacting and destroying it, recognizing it as foreign. But sometimes, the exuberance of the immune defenses is unleashed and becomes decidedly excessive, resulting in a number of undesirable effects. Which it is important to be aware of, in order to prevent and better manage them. Dr. Sabrina Chiloiro and colleagues from the UOC of Endocrinology and Diabetology at Fondazione Policlinico Gemelli, directed by Professor Alfredo Pontecorvi, take stock of the endocrinological complications of immunotherapy, which were also the subject of a recent publication in the prestigious journal Trends in Endocrinology & Metabolism (of the Cell Group).”The frequency of endocrinological disorders related to immunotherapy,” recalls Dr. Chiloiro, researcher in Endocrinology at the Catholic University of the Sacred Heart, “varies from 4 to 14.6 percent of treated patients. Among the most frequent side effects of these therapies are thyroid dysfunction (in particular thyroiditis, which can appear weeks-months after immunotherapy administration and usually evolve to hypothyroidism) and pituitary disorders (hypophysitis with hypopituitarism, which can cause in particular isolated ACTH deficiency, but also secondary hypogonadism and hypothyroidism) that typically appear at 9 weeks after the start of immunotherapy but, also much later. Rare, but reported in the literature, are also cases of insulin-dependent diabetes (which begin with severe hyperglycemia and diabetic ketoacidosis) and primary adrenal insufficiency. “Many of these endocrinologic problems,” recalls Professor Alfredo Pontecorvi, Full Professor of Endocrinology and Director of the UOC of Endocrinology and Diabetology at Fondazione Policlinico Gemelli, “can become chronic and thus require hormone replacement therapies. Conversely, these endocrinopathies, if not recognized and treated promptly, can give even very serious outcomes.””The undesirable effects of immunotherapy,” comments Professor Giampaolo Tortora, full professor of medical oncology and director of the Comprehensive Cancer Center of the Fondazione Policlinico Gemelli, “can be successfully managed thanks to a multidisciplinary collaboration between endocrinologists and oncologists; this allows not only to supervise the patient’s safety but also to offer him the possibility to complete, without interruption, the immunotherapy cycles, which are precious for the success of cancer treatment.”Immunotherapy,” recalls Professor Giovanni Scambia, Director of the UOC of Gynecologic Oncology and Scientific Director of Fondazione Policlinico Universitario Agostino Gemelli IRCCS, “is a therapeutic resource that is now indispensable for a number of gynecologic cancers, such as those of the endometrium, cervix and some forms of breast cancer. Having created, through a dedicated outpatient space, a direct thread with endocrinology allows us to manage our patients better and better, taking full advantage of the benefits of immunotherapy, in complete safety.””It may not be easy to diagnose these endocrinologic side effects,” Dr. Chiloiro recalls, “because they often begin with nonspecific symptoms such as great fatigue (fatigue) or headache; the interpretation of laboratory tests can also be difficult because the concomitant use of drugs such as corticosteroids and antiemetics can alter endocrinologic tests, as can stress and the patient’s own condition. It is therefore critical that people treated with immunotherapies be closely monitored to catch the onset of an endocrinological problem in the bud.” Particularly at risk are individuals with a history of previous autoimmune disease, people who are overweight/obese, those who have been on immunotherapy for a long period of time; while women and younger patients are at higher risk for thyroid disease.”Our advice,” Professor Pontecorvi concludes, “is to ask for complete endocrinological examinations (blood glucose, electrolytes, TSH, fT3, fT4, ACTH, cortisol, FSH, LH, prolactin, IGF-1, testosterone or estradiol) before starting immunotherapy. During treatment, the timing of comprehensive hormone testing should be planned according to the individual patient’s risk of developing endocrinologic toxicities, especially in the first few months of treatment and in patients with previous thyroid or autoimmune disease. Before each course of immunotherapy, we recommend in each patient to investigate the onset of symptoms attributable to endocrinologic dysfunction, and to perform hormonal examinations to reevaluate thyroid and adrenal function.Therefore, a close alliance between oncologist and endocrinologist is necessary for an accurate and timed evaluation of these patients in the outpatient clinic, during cancer treatment, but also after its discontinuation; endocrinologic side effects may in fact appear even 6 months after the discontinuation of immunotherapy.”
– Photo: Gemini Press Office –
(ITALPRESS).
