Endocrinopatias em pacientes oncológicos tratados com imunobiológicos

Abstract

Introduction: Immunotherapy consolidates immuno-oncology as an important therapeutic component in the fight against several types of cancer. They are drugs that modulate the immune system, enabling an adequate response to the disease and avoiding mechanisms of tumor evasion. Among the drugs most used in this immunotherapy, there are monoclonal antibodies that inhibit CTLA- 4 and PD-1 inhibitors. However, its own mechanisms of action predispose to imbalance in the regulation of immunological pathways, constituting an important adverse effect of this therapy, resulting in immune-mediated toxicity to organs and tissues, which manifests itself in gastrointestinal, hepatic, cutaneous and endocrine alterations, such as hypophysitis, thyroid diseases, primary adrenal insufficiency and type 1 diabetes mellitus. Objectives: To describe endocrine and metabolic abnormalities found during the use of immunotherapy to oncological diseases. Methodology: Medical records of cancer patients with more than eighteen years old in immunotherapy were selected in two oncology services in the city of Belém - Pará. Data were collected from June 2020 to March 2021, using questionnaires developed by the researchers of this study, containing the following variables aimed to identify endocrine abnormalities in this population: age; sex; diagnosis; immunobiological in use; time of treatment; frequently reported symptoms; dosage of LH, FSH, estradiol, testosterone, prolactin, TSH, free T4, ACTH, cortisol, IGF-1, GH, fasting glucose level, sodium and potassium. Results: In the two oncology services participating in this research, twenty- seven patients were using immune checkpoint inhibitors and had their medical records analyzed. However, only five medical records met the necessary inclusion criteria for this study. In this series of cases, the patients were on immunotherapy with pembrolizumab and nivolumab, for periods varying between 8 and 144 weeks. Of these, only two had clinical complaints that could be related to signs of endocrinopathies. In the analysis of laboratory tests, one patient presented changes in thyroid hormones, three patients presented changes in the gonadal axis and three patients presented changes in blood glucose. Conclusion: The clinical pattern suggestive of endocrinopathies did not appear uniformly in all exposed cases, even diverging from the pattern classically reported in previous studies. In this study, among the evaluated patients were found: glycemic alterations, thyroid dysfunction, increased levels of gonadotropins and increased estradiol. Among these, only thyroid dysfunction is commonly reported in the literature. It is essential that the clinical team responsible for the therapeutic follow-up of these patients adequately follow the recommendations for the early identification of immunomediated adverse events related to the endocrine system.