Preoperative testing for immunotherapy-induced endocrinopathy in breast cancer: Real-world data, literature review, and suggested management protocol: Integrating clinical experience and research to guide presurgical evaluation

Gerard Mccabe; Arran Turnbull; Dhananjay Kulkarni

doi:10.28982/josam.8398

Authors

Gerard Mccabe Edinburgh Breast Unit, Western General Hospital, NHS Lothian, Edinburgh, United Kingdom https://orcid.org/0000-0002-6648-4381
Arran Turnbull Edinburgh Cancer Research, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, United Kingdom https://orcid.org/0000-0002-2287-0889
Dhananjay Kulkarni Edinburgh Breast Unit, Western General Hospital, NHS Lothian, Edinburgh, United Kingdom https://orcid.org/0009-0009-8631-7757

DOI:

https://doi.org/10.28982/josam.8398

Keywords:

Pembrolizumab, pre-assessment, endocrinopathy, Breast Cancer

Abstract

Background/Aim: Triple-negative breast cancer (TNBC) is an aggressive subtype for which pembrolizumab-based neoadjuvant therapy has demonstrated improved outcomes. However, immune checkpoint inhibitors, including pembrolizumab, are associated with endocrine toxicities such as hypothyroidism, hypophysitis, and adrenal insufficiency, which may significantly complicate perioperative care. This study aimed to evaluate real-world preoperative endocrine testing and propose a practical management protocol.

Methods: This retrospective study evaluated 28 patients with TNBC at Western General Hospital who received pembrolizumab before surgery between March 2023 and December 2024. Clinical data, endocrine function tests, surgical outcomes, and adverse events were analyzed.

Results: Endocrinopathies occurred in a subset of patients, including one case of hypothyroidism and two cases of adrenal insufficiency. Only 36% of patients underwent cortisol testing preoperatively.

Conclusion: We propose a protocol for routine preoperative endocrine screening in this population, including early-morning cortisol and thyroid function tests. Although the incidence is low, these complications may be severe, and implementing this protocol may reduce the risk of perioperative complications associated with immunotherapy-induced endocrinopathies.

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