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However, it is crucial to emphasize that all data supporting this rationale derive from in vitro cell culture studies, in vivo animal experiments in rats and swine, and mechanistic extrapolation from established neuroendocrine physiology

Heme oxygenase-1 expression in endothelial cells leads to decreased expression of vascular cell adhesion molecule-1 (VCAM-1) as well as the expression and release of chemokines and proinflammatory cytokines such as CC-chemokine ligand (CCL)2, also known as MCP-1 (Sacerdoti et al., 2005)

doi: 10.1007/s00253-020-10832-4 214 AzadMAKSarkerMWanD

For example, if someone has an endocrinopathy, where someone has a problem with the thyroid, we know that the thyroid has been damaged already, and if we are providing thyroid hormone replacement, we are able to continue checkpoint inhibitor therapy. Referral to an organ specialist or internist may be needed based on the treating clinicians comfort and knowledge about drug-mediated toxicities