Sudden onset type 1 diabetes mellitus induced by immune checkpoint inhibitors in the treatment of advanced cancer. Cases report
DOI:
https://doi.org/10.47196/diab.v57i2.628Keywords:
type 1 diabetes mellitus, diabetic ketoacidosis, immune checkpoint inhibitorsAbstract
Three patients with advanced cancer, treated with inmune checkpoint inhibitors (ICIs), with no history of diabetes mellitus (DM), were admitted to the Emergency Department with polyuria, polydipsia, and weight loss and a diagnosis of diabetic ketoacidosis without clinical evidence of infection. They were treated with fluids and insulin infusion transitioning to a basal-bolus insulin regimen, which continued after discharge. Autoantibody detection tests for DM were negative and they were diagnosed with DM induced by ICIs, pembrolizumab in two of them, and nivolumab in another. The purpose of this case report is to show the development of DM1 in an acute form in patients treated with PD-1 inhibitors. Based on these cases and the reviewed literature, we seek to identify clinical characteristics and suggest strategies for the proper identification, control, treatment, and follow-up of patients treated with ICIs to minimize the impact of autoimmune dysfunction.
References
I. Smith CJ, Almodallal Y, Jatoi A. Rare adverse events with programmed death-1 and programmed death-1 ligand inhibitors. Justification and rationale for a systematic review. Curr Oncol Rep 2021;23:86.
II. Spain L, Diem S, Larkin J. Management of toxicities of immune checkpoint inhibitors. Cancer Treat Rev 2016;44:51-60.
III. Bristol-Myers Squibb. Opdivo® (package insert). Princeton, New Jersey: Bristol-Myers Squibb; 2018.
IV. Merck Sharpe and Dohme Company. Keytruda® (package insert). Whitehouse Station, New Jersey: Merck Sharpe and Dohme Company; 2016.
V. ElSayed NA, Aleppo G, Aroda VR, et al. Classification and diagnosis of diabetes: Standards of Care in Diabetes 2023. Diabetes Care 2023;46(Suppl. 1):S19-S40.
VI. de Filette J, Andreescu CE, Cools F, Bravenboer B, Velkeniers B. A systematic review and meta-analysis of endocrine-related adverse events associated with immune checkpoint inhibitors. Horm Metab Res 2019;51:145-156.
VII. Stamatouli AM, Quandt Z, Perdigoto AL, et al. Collateral damage: insulin-dependent diabetes induced with checkpoint inhibitors. Diabetes 2018;67:1471-80.
VIII. Hughes J, Vudattu N, Sznol M, et al. Precipitation of autoimmune diabetes with anti-PD-1 immunotherapy. Diabetes Care 2015;38:e55-e57.
IX. Quandt Z, Young A, Anderson M. Immune checkpoint inhibitor diabetes mellitus: a novel form of autoimmune diabetes. Clin Exp Immunol 2020;200:131-140.
X. Irani AZ, Almuwais A, Gibbons H. Immune checkpoint inhibitor-induced diabetes mellitus with pembrolizumab. BMJ Case Rep 2022;15:e245846. doi:10.1136/bcr-2021- 245846.
XI. Nogueira E, Newsom-Davis T, Morganstein DL. Immunotherapy-induced endocrinopathies: assessment, management, and monitoring. Ther Adv Endocrinol Metab 2019;10:2042018819896182.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 on behalf of the authors. Reproduction rights: Argentine Diabetes Society
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Dirección Nacional de Derecho de Autor, Exp. N° 5.333.129. Instituto Nacional de la Propiedad Industrial, Marca «Revista de la Sociedad Argentina de Diabetes - Asociación Civil» N° de concesión 2.605.405 y N° de disposición 1.404/13.
La Revista de la SAD está licenciada bajo Licencia Creative Commons Atribución – No Comercial – Sin Obra Derivada 4.0 Internacional.
Por otra parte, la Revista SAD permite que los autores mantengan los derechos de autor sin restricciones.
