New-Onset Type 1 Diabetes Mellitus After Treatment With Nivolumab for Melanoma

Baroud, Sarah; Mirza, Lubna

doi:10.7759/cureus.18679

Cited by 4 publications

(4 citation statements)

References 4 publications

(7 reference statements)

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“…DRB1, DQA1, and DQB1). [4][5][6][7] Acute-onset autoimmune diabetes with positive GAD65 antibodies has been uniquely correlated with HLA DRB1 in particular. [5][6][7] In our patient, HLA genotyping was performed via DNA-based molecular techniques from a whole blood patient sample.…”

Section: Discussionmentioning

confidence: 99%

Nivolumab-induced autoimmune diabetes mellitus presenting as diabetic ketoacidosis in a patient with metastatic mucosal melanoma

Goff

Plaxe

White

et al. 2023

J Oncol Pharm Pract

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Introduction Nivolumab is an immune checkpoint inhibitor used in the treatment of several malignancies. A number of immune-related endocrinopathies have been linked to its use. Case report We report a unique case of a 74-year-old man with well-controlled diabetes mellitus type 2 and metastatic mucosal anorectal melanoma who presented with diabetic ketoacidosis after receiving his third cycle of nivolumab 240 mg intravenous (IV) every 2 weeks. He was found to have autoantibodies against glutamic acid decarboxylase 65. Genotyping for human leukocyte antigens showed the presence of DQB1*02:01 and DRB1*03:01. Management and outcome His presentation was complicated by acute renal failure. He required aggressive fluid resuscitation and insulin supplementation to reverse severe acid–base disturbance and multiple electrolyte abnormalities. After an 8-week interruption, the patient restarted nivolumab without any further evidence of adverse events over the next 12 weeks. He continues to require insulin replacement therapy. Discussion and conclusion Development of type 1 diabetes with the use of immune checkpoint inhibitors has been increasingly reported in the literature. The exact mechanism for autoimmune diabetes precipitated by nivolumab is yet to be elucidated. Patient education about the symptoms of diabetes and regular glucose monitoring cannot be overemphasized. Testing for antibodies against glutamic acid decarboxylase 65, insulin receptors, and islet cells may also prove useful. Human leukocyte antigen DQ and DR haplotyping prior to immune checkpoint inhibitor treatment might help determine susceptibility toward developing type 1 diabetes, and provide opportunities for earlier recognition, intervention, and possibly prevention.

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Section: Discussionmentioning

confidence: 99%

Nivolumab-induced autoimmune diabetes mellitus presenting as diabetic ketoacidosis in a patient with metastatic mucosal melanoma

Goff

Plaxe

White

et al. 2023

J Oncol Pharm Pract

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“…Учитывая стремительное течение развития заболевания, следует отметить, что уровень глюкозы должен непрерывно контролироваться. Точный патофизиологический механизм и прогностические биомаркеры возникновения данного состояния еще не установлены [36].…”

Section: Discussionunclassified

“…Генетические факторы риска включают лиц с генотипами риска HLA DR 3/4-DQ8 или DR 4/DR 4 и отягощенным семейным анамнезом [20,21]. Негенетические факторы риска включают в себя иммунизацию, диету, социальноэкономический статус, ожирение, дефицит витамина D, перинатальные факторы и наличие в анамнезе вирусных инфекций, в частности энтеровирусных инфекций.…”

Section: Introductionunclassified

Anti-PD‑1-induced type 1 diabetes mellitus in patient with recurrent oropharyngeal squamous cell cancer

Lyanova¹,

Vladimirova²,

Абрамова³

et al. 2023

Medicinskij alfavit

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Ростов-на-Дону 2 Больница Christiana Care, г. Ньюарк, штат Делавэр, США РЕЗЮМЕ Ингибиторы иммунных контрольных точек, нацеленные на запрограммированный лиганд гибели клеток PD-L1, стали крупным прорывом в лечении многих онкологических заболеваний. Ниволумаб -это антитело, избирательно блокирующее рецептор PD-1 на поверхности цитотоксических Т-клеток для предотвращения подавления регуляции иммунного ответа. Известно, что ингибиторы иммунных контрольных точек могут вызывать так называемые иммуноопосредованные нежелательные явления, в том числе со стороны эндокринной системы. Сахарный диабет 1 типа является одним из тяжелых редких и потенциально опасных для жизни иммуноопосредованных нежелательных явлений, встречающихся менее чем у 1 % пациентов, получающих лечение ингибиторами иммунных контрольных точек. Хотя общая частота сахарного диабета 1 типа, связанного с ингибитором PD-1, относительно низка, тем не менее он имеет молниеносное течение и может представлять потенциальную угрозу для жизни пациентов, если не будут проведены своевременная диагностика и лечение. Поскольку ингибиторы PD-1 широко используются для лечения многих злокачественных заболеваний, осложнения в виде диабета 1 типа должны привлекать внимание врачей. Кроме того, нельзя не учитывать тот факт, что в ходе лечения врачи должны помогать пациентам лучше распознавать симптомы гипергликемии или диабетического кетоацидоза, что требует тщательного наблюдения за ними во время лечения, регулярного мониторинга уровня глюкозы в плазме крови, оперативного выявления и правильной диагностики и лечения диабета.

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“…This event, which is most noticeable in cancer patients who receive immunotherapy treatment, demonstrates that previously working beta cells begin to express non-functional proteins, a characteristic trait of cancer cells. This triggers the usual antitumor reaction of the immune system against these pancreatic cells, which could explain why some cancer patients develop T1DM after receiving immunotherapy [ 13 ]. Anti-PD-1-related T1DM cases have yielded mixed results in terms of the prevalence of diabetes-related autoantibodies after the onset of T1DM.…”

Section: Discussionmentioning

confidence: 99%

Rare Adverse Events Related to Nivolumab, an Immune Checkpoint Inhibitor: A Case Series

Ganta¹,

Alnabwani²,

Keating³

et al. 2022

Cureus

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Immune checkpoint inhibitors are a novel class of immunotherapy drugs that have improved the prognosis of melanoma, renal cell carcinoma, non-small cell lung cancer, urothelial carcinoma, and various other solid tumors. Nivolumab is an immune checkpoint inhibitor that acts by inhibiting programmed death. Its use is associated with significant immune-related adverse events, such as pneumonitis, thyroiditis, hepatitis, pruritus, vitiligo, and diarrhea. However, adrenal insufficiency and checkpoint inhibitor-related autoimmune diabetes mellitus are extremely rare adverse events related to nivolumab treatment. Here, we are highlighting cases of adrenal insufficiency and diabetes inspidus as a result of nivolumab. These rare adverse events in our case series are to raise awareness that this medication also may be the cause for this illness among oncologists, endocrinologists, internists, and other clinicians.

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New-Onset Type 1 Diabetes Mellitus After Treatment With Nivolumab for Melanoma

Cited by 4 publications

References 4 publications

Nivolumab-induced autoimmune diabetes mellitus presenting as diabetic ketoacidosis in a patient with metastatic mucosal melanoma

Nivolumab-induced autoimmune diabetes mellitus presenting as diabetic ketoacidosis in a patient with metastatic mucosal melanoma

Anti-PD‑1-induced type 1 diabetes mellitus in patient with recurrent oropharyngeal squamous cell cancer

Rare Adverse Events Related to Nivolumab, an Immune Checkpoint Inhibitor: A Case Series

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