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irAE Endocrinopathy — SCE Medical Oncology MCQ

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ModerateImmunotherapy & Targeted TherapyirAE EndocrinopathySCE Medical Oncology

A 55-year-old woman on pembrolizumab for NSCLC develops new-onset type 1 diabetes (DKA presentation). After stabilisation with insulin, she asks whether pembrolizumab can be restarted. What is the recommendation?

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Correct answer: A — Pembrolizumab can be restarted once insulin replacement is stable and glucose is well controlled — ICI-induced endocrinopathies managed with hormone replacement do NOT require permanent ICI discontinuation

ICI-induced endocrinopathies (hypothyroidism, hypophysitis, type 1 diabetes, primary adrenal insufficiency) that are managed with adequate hormone replacement generally do NOT require permanent ICI discontinuation. This is a key exception to the general rule that grade 3-4 irAEs require permanent ICI cessation. Once the patient is stable on appropriate hormone replacement (insulin, levothyroxine, hydrocortisone as appropriate), ICI can be cautiously restarted with close monitoring.

Reference: ESMO 2024 irAE Management Guidelines; ASCO Endocrine irAE Guidelines 2021