THU513 Are Endocrinologists Using CTCAE Grading System For Endocrine Side Effects Of Cancer Treatment With Immune Checkpoint Inhibitors?
Authors: Arnouk Nelly , AbuOmar Samah , Halik Abraham , Saif Aneeqa , Schroeder Pamela Rose 
Published: October 2023

Abstract
Disclosure: N. Arnouk: None. S. AbuOmar: None. A. Halik: None. A. Saif: None. P.R. Schroeder: None.
Introduction: Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of diverse types of cancer but can have serious endocrine system side effects. Common Terminology Criteria for Adverse Events (CTCAE) is a grading system for ICI side effects used by oncologists to aid in treatment decisions. We hypothesize that endocrinologists are not involved in managing immune-related adverse events (irAEs) and are not aware of the CTCAE grading system. Further, we hypothesize that endocrinologists in an academic setting are more likely to use CTCAE compared to endocrinologists in community setting. Methods: A retrospective review of 800 charts in our EMR from January 2018-July 2022 for patients seen in outpatient oncology and endocrinology clinics in our large Mid-Atlantic hospital system. Inclusion criteria were age ≥18 years; diagnosis of advanced melanoma, metastatic non-small cell cancer, head and neck squamous cell cancer, urothelial carcinoma, gastric adenocarcinoma, Hodgkin lymphoma, hepatocellular carcinoma, breast cancer, and renal cell carcinoma; and treatment with one or more ICIs. Patients with endocrinopathies due to chemotherapy or other classes of cancer treatment, no ICI treatment, or pre-existing endocrinopathies were excluded, thus 677 were analyzed.We also surveyed all endocrinologists practicing in our hospital network to determine whether they are involved in managing endocrinopathies associated with ICIs and whether they use the CTACE grading system. Results: Of the 677 reviewed 124 (18%) developed irAEs. In 74 (60%) of those cases, an endocrinologist was involved in management, 47 (70%) in community hospitals and 27 (47%) in academic centers. CTCAE was used in one case. Of 24 endocrinologists surveyed (14 practicing in academic centers and 10 practicing in community centers),12 (50%) responded, 3 (25%) at academic centers and 9 (75%) at community centers. Of the respondents, 9 (75%) said they sometimes are involved in managing irAEs due to ICIs, 11 (91%) had never used the CTCAE, 8 (67%) would participate in a multidisciplinary clinic to manage irAEs, and 6 (50%) preferred to see the patient in their regular clinic. Conclusion: In this study, 60% of the irAE cases resulting from ICI immunotherapy were managed by an oncologist and endocrinologist. CTCAE was used in only one case. More endocrinologists in the community were involved in management of these patients than those in academic centers. A majority of endocrinologists surveyed said they are sometimes consulted in these cases but only one had used CTCAE, thus CTCAE was not used more frequently in an academic versus community setting. More than half prefer to treat these patients in regular versus multidisciplinary clinics. More endocrinologists need to be aware of and use the CTCAE to foster a multidisciplinary team approach to treating endocrinopathies associated with ICIs.
Presentation: Thursday, June 15, 2023