Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management
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SPECIAL ARTICLE
Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management of immune checkpoint inhibitor endocrinopathies and the role of advanced practice providers in the management of immune-mediated toxicities Tim Cooksley 1 & Monica Girotra 2,3 & Pamela Ginex 4 & Ruth Ann Gordon 5 & Ronald Anderson 6 & Ada Blidner 7 & Jennifer Choi 8 & Michael Dougan 9 & Ilya Glezerman 10 & Dipti Gupta 11 & Douglas Johnson 12 & Vickie R. Shannon 13 & Maria Suarez-Almazor 14 & Bernardo L. Rapoport 6,15 Received: 23 April 2020 / Accepted: 20 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Immune checkpoint inhibitors (ICIs) have emerged as the newest pillar of cancer treatment, transforming outcomes in melanoma and showing benefit in a range of malignancies. Immune-mediated toxicities, stemming from increased activity within the T cell lineage, range from asymptomatic or mild complications to those that are fulminant and potentially fatal. Immune-mediated endocrinopathies include hypophysitis, thyroiditis, and insulin-dependent diabetes mellitus. These presentations, which may be vague and non-specific, can be life-threatening if not diagnosed and treated appropriately. This review considers the work-up and management of immune-mediated endocrinopathies and also considers the role of advanced practice practitioners in the management of immune-mediated toxicities. These state-of-the-art MASCC recommendations represent a comprehensive overview of the management and clinical work-up in those in whom the diagnosis should be considered. Keywords APPs (advanced practice providers) . Corticosteroids . Diabetes . Hyperglycemia . Hypophysitis . Thyroiditis
Tim Cooksley and Monica Girotra are joint first authors. * Bernardo L. Rapoport [email protected] Tim Cooksley [email protected] Monica Girotra [email protected] Pamela Ginex [email protected] Ruth Ann Gordon [email protected] Ronald Anderson [email protected] Ada Blidner [email protected] Jennifer Choi [email protected]
Michael Dougan [email protected] Ilya Glezerman [email protected] Dipti Gupta [email protected] Douglas Johnson [email protected] Vickie R. Shannon [email protected] Maria Suarez-Almazor [email protected] Extended author information available on the last page of the article
Support Care Cancer
Introduction This contribution to the 2020 MASCC recommendations on the management of immune-related toxicities is focused on endocrinopathies and emerging toxicities, specifically the approach to the more severe presentations which require corticosteroids and specialist management. We also consider the role of advanced care practitioners in the management of these toxicities.
Endocrinopathies Immune-related endocrinopathies from checkpoint inhibitor therapy include most commonly hypophysitis, thyroiditis, and, albeit less commonly, insulin-dependent diabetes mellitus and adrenalitis [1]. These can be life-threat
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