Managing Thyroid Adverse Events From Checkpoint Inhibitors

Drs Kaniksha Desai and Afreen Shariff discuss the thyroid immune-related adverse effects of immune checkpoint inhibitors.
https://www.medscape.com/viewarticle/...

-- TRANSCRIPT --
Kaniksha Desai, MD: Welcome to the Thyroid Stimulating Podcast. This podcast was created in partnership with the American Thyroid Association to discuss up-to-date diagnosis and management of a wide array of thyroid diseases.

For today's episode, we are focusing on a very specific, yet increasingly relevant topic: the thyroid immune-related adverse effects of immune checkpoint inhibitors, a groundbreaking class of drugs that have revolutionized cancer treatment but come with their own set of challenges.

We'll explore the mechanisms of action of immune checkpoint inhibitors, then delve into the common thyroid-related adverse effects these treatments can induce, and then discuss how these are diagnosed, managed, and monitored in clinical practice.

Joining us today is Dr Afreen Shariff, an associate professor of medicine at Duke University School of Medicine, with expertise in endocrine diseases in cancer patients.

Dr Shariff completed her internal medicine training at East Carolina University's Brody School of Medicine and fellowship in endocrinology from Duke University School of Medicine.

She is currently the director of the Duke Endo-Oncology Program and an associate director for the Cancer Therapy Toxicity Program at the Duke Center for Cancer Immunotherapy.

Her clinical work and research are focused on high-value care for managing endocrine diseases in cancer patients, for which she has received the 2023 Innovator Award from the Association of Community Cancer Centers and now serves on their board of trustees.

Additionally, she is the host of a medical podcast series, Checkpoint NOW, where she highlights shared decision-making between oncologists and subspecialists for management of checkpoint inhibitor toxicities. Thank you for joining us today.

Afreen Shariff, MD: Thank you for having me on the podcast today. It's such a delight to meet you and record this podcast.

Desai: I wanted to start by quickly reviewing checkpoint inhibitors, a brief background about them, and how they've changed the landscape of oncology.

Shariff: Absolutely. Now, 2011 really marked a pivotal moment in oncology with the approval of ipilimumab, the first US Food and Drug Administration (FDA)-approved immune checkpoint inhibitor for nondetectable metastatic melanoma.

Following suit, in 2014, pembrolizumab and nivolumab gained FDA approval for melanoma treatment. Since then, there has been a remarkable surge in FDA approvals exceeding 50-plus indications, with several more in the pipeline. Undoubtedly, this has revolutionized the approach of oncologists toward patient care.

Presently, checkpoint inhibitors are being integrated into combination chemotherapy regimens for adjuvant, neoadjuvant, and early-stage cancers, really reflecting a significant shift in treatment paradigms. In short, immune checkpoint inhibitors have really taken the market by storm and are here to stay.

Desai: Since they're here to stay, we've also noticed some significant side effects from these medications. This podcast focuses on thyroid, so I wanted to go over some of the common thyroid-related adverse effects associated with the use of these immune checkpoint inhibitors.

Shariff: The most common one that we encounter, seen in about 15% patients, is immune-related thyroiditis, which presents very similarly to traditional thyroiditis, except I call it the cousin of the same family because the presentation and the phenotypic description of patients is a little different from what we see in traditional practice.

What we end up seeing more commonly, in about 15% of patients, is thyroiditis, and less commonly, Graves disease, which is seen in less than 1% of patients.

Desai: Do you ever see hypothyroidism?

Shariff: We do. It's quite common, actually, to see patients with hypothyroidism. In fact, when we talk about thyroiditis, we're talking about a movement in the patient's thyroid from being thyrotoxic to what we call a hypothyroid state.

The way I explain this in very simple terms: The thyroid gland is a water balloon full of thyroid hormone. When these immune checkpoint inhibitors really hit the thyroid gland, that balloon breaks up into pieces.

Transcript in its entirety can be found by clicking here:
https://www.medscape.com/viewarticle/...