Endocrinologist Tackles Side Effects of Immunotherapy Cancer Treatments

Preserving quality of life is key to responding to Immune-related Adverse Events

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A Duke endocrinologist works closely with oncologists at the Duke Cancer Center to serve the growing clinical demands of nearly 200 patients with Immune-related Adverse Events (irAEs), a recently recognized condition that occurs as a result of new cancer treatments such as immune checkpoint inhibitors.

Afreen Shariff, MD, has also launched clinical studies within the Duke Division of Endocrinology, Metabolism and Nutrition to help quantify and publish information about the endocrine complexities associated with irAEs.

Most patients presenting to Shariff with endocrine-related reactions to checkpoint inhibitors are referred by Duke oncologists helping patients respond to melanomas, lung, gastrointestinal, genitourinary cancers and those enrolled in ongoing clinical trials.

Endocrine effects of irAEs vary significantly, Shariff says, from commonly occurring thyroid and pituitary dysfunction to relatively rare conditions such as primary adrenal insufficiency. Some patients can also develop Type 1 Diabetes Mellitus which can be a life changing diagnosis for patients already dealing with cancer.

The full effects of checkpoint inhibitors are not completely understood, Shariff cautions, but timely diagnosis and endocrine focused treatment can significantly improve the quality of life in patients. However, if not diagnosed and treated promptly, some endocrine conditions can be life threatening.

“Fortunately, when recognized and diagnosed promptly, these conditions can be appropriately managed,” she says. “Given the risk of cancer progression, I do not recommend stopping checkpoint inhibitors. My goal is to manage the endocrine side effects while their cancer treatment continues. In general most endocrine side effects are treated by taking medications.”

Shariff notes that some patients may have pre-existing endocrine diseases that respond differently following the initiation of  immunotherapy. Oncologists who trained to recognize that some patients receiving immunotherapy require additional treatment triage them based on symptoms and diagnostic tests and refer them for further evaluation.

Shariff collaborates with patients’ oncologists and often initiates care while patients are in the ER or recently admitted to the hospital by offering recommendations to direct diagnosis and early therapies. “Since this is a new area in endocrinology, care of these patients is dependent on evidence from emerging data,” Shariff says. “But, it’s rewarding to reassure these patients that their immunotherapy can continue while we restore their quality of life in most cases,” Shariff says.

Clinical trials involving immunotherapies report information about endocrine side effects but lack specific information that may be valuable in clinical decision making for individual patients. Shariff says she works to develop more effective ways to describe, predict and manage these now commonly occurring side effects