Pembrolizumab-induced type 1 diabetes.

IF 1 4区 医学 Q4 ONCOLOGY
Journal of Oncology Pharmacy Practice Pub Date : 2024-09-01 Epub Date: 2024-05-20 DOI:10.1177/10781552241255699
Ariana Maia, Daniela M Soares, Sofia Azevedo, Teresa Pereira, Cláudia Amaral
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引用次数: 0

Abstract

Introduction: Immunotherapy has a crucial role in the current treatment of multiple malignancies. Albeit described as rare, new onset autoimmune diabetes is a potentially life-threatening complication of programmed cell death-1 (PD-1) inhibitors, such as pembrolizumab, and its predisposing factors and pathological mechanism are yet to be clarified.

Case report: We present a case of a 72-year-old man with a high-grade bladder carcinoma undergoing pembrolizumab treatment. He had no personal or family history of diabetes mellitus but was diagnosed with primary hypothyroidism four months after starting pembrolizumab. Two years after starting pembrolizumab, he presented in the emergency department due to abdominal pain, anorexia, polydipsia, polyuria and vomiting over the preceding five days and he met criteria for severe diabetic ketoacidosis (DKA). Three days prior to his admission, he had received prednisolone therapy for suspected hypersensitivity related to a contrast-enhanced imaging that he performed.

Management & outcome: Prompt treatment for DKA was started, with transition to insulin basal-bolus therapy after DKA resolution, with progressive glycaemic stabilization. Further investigation revealed low C-peptide levels (0.07 ng/dL, with a fasting blood glucose of 288 mg/dL), HbA1c 9.2% and positive anti-IA2 antibodies, which allowed the diagnosis of new-onset autoimmune diabetes. Pembrolizumab was transiently suspended, and the patient resumed treatment after glycaemic profile optimization under multiple daily insulin administrations two months later.

Discussion: This case highlights the importance of clinical suspicion and glycaemic monitoring as an integral part of treatment protocols in patients on pembrolizumab and other immune checkpoint inhibitors. Additional research and investigation into the underlying mechanisms of this condition are necessary to identify potential screening tests for individuals at higher risk of developing DM and to guide the implementation of management and preventive strategies for ketoacidosis complication.

Pembrolizumab 诱导的 1 型糖尿病。
简介免疫疗法在目前多种恶性肿瘤的治疗中发挥着至关重要的作用。尽管被描述为罕见,但新发自身免疫性糖尿病是程序性细胞死亡-1(PD-1)抑制剂(如 pembrolizumab)的一种潜在威胁生命的并发症,其诱发因素和病理机制尚未明确:我们报告了一例 72 岁男性高级别膀胱癌患者接受 pembrolizumab 治疗的病例。他没有个人或家族糖尿病史,但在开始使用 pembrolizumab 四个月后被诊断为原发性甲状腺功能减退症。在开始使用 Pembrolizumab 两年后,他因腹痛、厌食、多饮、多尿和呕吐而到急诊科就诊。入院前三天,他曾接受过泼尼松龙治疗,原因是怀疑他对造影剂过敏:及时开始治疗 DKA,DKA 缓解后转为胰岛素基础治疗,血糖逐渐稳定。进一步检查发现,患者的C肽水平较低(0.07纳克/分升,空腹血糖为288毫克/分升),HbA1c为9.2%,抗IA2抗体阳性,因此诊断为新发自身免疫性糖尿病。患者暂时停用了 Pembrolizumab,两个月后,在每天多次使用胰岛素的情况下,患者的血糖情况得到优化,并恢复了治疗:本病例强调了临床怀疑和血糖监测的重要性,这是使用 pembrolizumab 和其他免疫检查点抑制剂的患者治疗方案中不可或缺的一部分。有必要对这一病症的潜在机制进行更多的研究和调查,以确定对罹患糖尿病风险较高的个体进行筛查的可能性,并指导酮症酸中毒并发症的管理和预防策略的实施。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.70
自引率
7.70%
发文量
276
期刊介绍: Journal of Oncology Pharmacy Practice is a peer-reviewed scholarly journal dedicated to educating health professionals about providing pharmaceutical care to patients with cancer. It is the official publication of the International Society for Oncology Pharmacy Practitioners (ISOPP). Publishing pertinent case reports and consensus guidelines...
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