Atezolizumab-induced autoimmune diabetes mellitus presenting as diabetic ketoacidosis and Takotsubo cardiomyopathy

Abstract

Atezolizumab is a humanised monoclonal IgG1 antibody that is used in treating many solid malignancies. Endocrinopathies are known but a rare adverse event of these immunotherapeutic drugs. Autoimmune diabetes induced by atezolizumab has been rarely reported in the literature. We report the case of a woman in her eighth decade with no known history of diabetes who developed new-onset autoimmune diabetes and Takotsubo cardiomyopathy due to the adverse effects of atezolizumab therapy for hepatocellular carcinoma. We also review the characteristics and outcomes of cases previously reported in the literature.

Takotsubo Cardiomyopathy in Cancer Patients Treated with Immune Checkpoint Inhibitors: A Systematic Review and Meta-Summary of Included Cases

“…Other possible stressors included the presence of non-cardiac irAEs [15,[17][18][19]23,26,28,29], infections [21], and infusion reactions [16]. Other risk factors, such as active smoking and cardiovascular comorbidities, have been previously described [14] and were also identified in our study [17][18][19].…”

“…Of the seventy-seven articles initially retrieved through the literature search, fifteen met all eligibility criteria and were included in the systematic review [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. One additional unpublished case from the Third Department of Internal Medicine, Sotiria General Hospital for Chest Diseases, National and Kapodistrian University of Athens, Athens, Greece, was also included.…”

Systemic therapies in hepatocellular carcinoma: A revolution?

“…On the other hand, there are several case reports showing the unpredictable and infrequent severe side effects with different outcomes, such as atezolizumab‐induced encephalitis, 34 , 35 hypopituitarism, 36 polymyalgia rheumatica, 37 adrenocorticotropic hormone deficiency, hypothyroidism and myopathy 38 myocarditis, 39 psoriasiform eruption, 40 autoimmune diabetes mellitus, Takotsubo cardiomyopathy, 41 small bowel perforation, 42 Evans' syndrome, 43 duodenal variceal rupture, 44 liver abscess, 45 thrombotic microangiopathy and mesangial proliferative glomerulonephritis during atezolizumab and bevacizumab treatment. 46 Case reports are scanty in the case of tremelimumab and durvalumab and only a shellfish allergy after treatment has been described but there is less available data due to the late incorporation.…”