medwireNews: The European Society for Paediatric Endocrinology (ESPE) has released a position statement to encourage further research into endocrine immune-related adverse events (irAEs) associated with the use of immune checkpoint inhibitors (ICIs) in children with cancer.
Acknowledging the “scarce” amount of literature on these in children, the ESPE Clinical Practice Committee members recommend that there should be enhanced monitoring for symptoms during and after treatment, with an interdisciplinary endocrinology–oncology approach to ensure prompt recognition and treatment of toxicities and deficiencies, and a focus on family education.
In addition, paediatric studies on irAEs of ICIs should be prioritised, they say, alongside the development of databases to record ICI-related endocrinopathies and help develop paediatric guidelines for ICI use.
“By addressing these gaps, we can ensure safer and more effective integration of ICIs into pediatric cancer care, with a focus on minimizing irAEs”, write Kanetee Busiah (Hopital de l’enfance de Lausanne, Switzerland) and fellow ESPE Clinical Practice Committee members in the statement published in Hormone Research in Paediatrics.
The team says that research in adults shows that ICI irAEs “often have irreversible effects on endocrine function” and usually occur within the first months of treatment but can emerge more than a year later, with combination ICI therapy associated with a greater risk of side effects.
The most common irAEs include diabetes, thyroid dysfunction, adrenal insufficiencies and hypophysitis, but the latter two side effects are “very rare” in children, the authors comment.
A literature reviews suggest ICI-induced diabetes may occur in 1–9% of children. Research indicates that high, low and undetectable levels of C-peptide are associated with three different phenotypes of diabetes in adults, with undetectable C-peptide plus positive islet-specific autoantibodies linked to “a more fulminant presentation”, comment Busiah et al.
The committee also notes that thyroid dysfunction is one of the most commonly reported ICI-related endocrine AEs in paediatric and adult patients, with hypothyroidism and hyperthyroidism reported in up to 20% and 15% of children, respectively. “All ICI can induce new-onset hypothyroidism or exacerbate pre-existing thyroid dysfunction”, they write, noting that the “recovery rate is poor”, but if the treatment is effective for the tumour, “thyroid replacement therapy is a manageable option.”
Recognising that irAE diagnosis “can be challenging since subtle, non-specific symptoms at presentation may be diagnosed as the natural course of cancer progression or cancer therapy”, the team advises that there should be “close monitoring” of patient symptoms and hormone levels, with regular pituitary, thyroid, adrenal and glucose function assessments before, during and after ICI therapy.
“Patients and families should receive education about the potential endocrine risks of ICIs and the importance of timely symptom reporting”, the authors add. “An emergency card for adrenal insufficiency should be given, especially in combination treatments with ICIs.”
By Lynda Williams
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