Immune checkpoint inhibitors (ICI) have revolutionized cancer treatment, but are associated
with significant autoimmune endocrinopathies that pose both diagnostic and treatment
challenges. The aim of this guideline is to provide clinicians with the best possible
evidence-based recommendations for treatment and follow-up of patients with ICI-induced
endocrine side effects based on the GRADE (Grading of Recommendations Assessment,
Development and Evaluation) system. As these drugs have been used a relatively short
time, large systematic investigations are scarce. A systematic approach to diagnosis,
treatment and follow-up is needed, including baseline tests of endocrine function
before each treatment cycle. We conclude that there is no clear evidence for the benefit
of high-dose glucocorticoids to treat endocrine toxicities with the possible exceptions
of severe thyroid eye disease and hypophysitis affecting the visual apparatus. With
the exception of thyroiditis, most endocrine dysfunctions appear to be permanent regardless
of ICI discontinuation. Thus, the development of endocrinopathies does not dictate
a need to stop ICI treatment.
