Thyroid and Cortisol Endocrinopathies and Survival in Cancer Patients Treated with Immune Checkpoint Inhibitors in UAE

Abstract Background Immune checkpoint inhibitors (ICIs) are associated with immune related adverse events (irAEs) of which endocrinopathies are among the most frequent. This study aimed to identify thyroid and cortisol related endocrine-related adverse events (ERAEs) in a cohort of patients treated with ICIs and to examine survival differences between patients who developed endocrinopathies and those who did not. Methods We conducted a retrospective review of electronic medical records of adult patients who received ICIs between 2018 and 2023. Data were collected specifically on thyroid and cortisol related ERAEs. Results Among 616 patients, 59 (9.6%) developed thyroid or cortisol related ERAEs. The mean time to onset was 22.7 weeks. All thyroid-related events were post-thyroiditis hypothyroidism (n = 55), while all cortisol-related events were due to ACTH deficiency (n = 11). The majority of these events occurred in patients treated with anti–PD-1 agents, the most commonly used therapy in this cohort. Patients who developed ERAEs demonstrated improved overall survival during the follow-up period compared to those without endocrine toxicity. Conclusions In this cohort, systematic monitoring identified thyroid- and cortisol-related ERAEs in 9.6% of patients, consisting exclusively of post-thyroiditis hypothyroidism and ACTH deficiency. The occurrence of these endocrinopathies was associated with a favorable survival trend, underscoring the importance of early recognition and management of endocrine irAEs in patients receiving ICIs.