Nivolumab-Induced Acute Diabetes Mellitus and Hypophysitis in a Patient with Advanced Pulmonary Pleomorphic Carcinoma with a Prolonged Tumor Response

Abstract

moreover, BRAF V600E was detected in 3% variant allelic frequency (Fig. 1A). The presence of BRAF V600E mutations was confirmed by amplification refractory mutation system polymerase chain reaction in plasma collected in March but not detected in January (Fig. 1B). These data provide confirmation of the role of BRAF V600E as a mechanism of escape after a third-generation EGFR tyrosine kinase inhibitor and suggest that liquid biopsy is suitable for detecting new molecular data regarding resistance. There was a consistency between progression as seen on CT scan and clinically and the presence of BRAF V600E in the cfDNA.The course of disease with this new oncogenic transformation was clinically very aggressive.

Spectrum of immune checkpoint inhibitors-induced endocrinopathies in cancer patients: a scoping review of case reports

“…During the preapproval and post-marketing periods there were 18 and 204 (166 in the first 4 years of marketing) respectively. There were 9 cases of polyglandular endocrinopathies involving anterior hypopituitarism - plus thyroiditis [31, 45, 89], plus primary hypothyroidism [60, 82, 90, 93], plus Graves’ disease and T1DM [76], and plus T1DM [95].…”

Hypophysitis secondary to nivolumab and pembrolizumab is a clinical entity distinct from ipilimumab-associated hypophysitis

“…Previously published cases of hypophysitis associated with anti-PD-1 agents were identified by searching PubMed for all English-language articles through December 1, 2018 utilizing the terms 'nivolumab hypophysitis', 'pembrolizumab hypophysitis', 'nivolumab adrenal insufficiency', 'pembrolizumab adrenal insufficiency', 'nivolumab hypopituitarism', 'pembrolizumab hypopituitarism', 'nivolumab ACTH', 'pembrolizumab ACTH'. Twenty-three case reports and letters were identified (7, 8, 9, 10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29). The full text of one manuscript could not be obtained (7).…”

“…Limitations in the existing common terminology criteria for adverse events (CTCAE), which contains multiple imprecise and overlapping endocrine categories, likely impact the accuracy of endocrine irAE reports in these trials. Clinical descriptions of patients diagnosed with hypophysitis following treatment with anti-PD-1 medications are very sparse and consist of case reports and letters with little or no longitudinal information (7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29). To our knowledge, no cohort study examining such patients has been published.…”

Type 1 Diabetes, ACTH Deficiency, and Hypothyroidism Simultaneously Induced by Nivolumab Therapy in a Patient with Gastric Cancer: A Case Report

“…Type 1 diabetes and hypopituitarism/hypophysitis are rarer conditions, which were reported in 0.9 and 0.3%, respectively [ 6 , 7 , 8 ]. There are some previous reports of type 1 diabetes with isolated ACTH deficiency induced by nivolumab in a patient with breast cancer, diabetes with hypophysitis in a patient with lung cancer, or nivolumab-induced type 1 diabetes with thyroiditis [ 9 , 10 , 11 ]. There is also a case of nivolumab-induced hypothyroidism associated with isolated ACTH deficiency reported previously [ 12 ].…”

“…Secondly, further hormone investigations should be taken into consideration when regular treatment intervention is not effective or unexplained symptoms are observed. In previous reports, there are 2 cases of endocrinopathies that developed within a month [ 9 , 10 ] and 2 cases that developed a couple of months later [ 11 , 12 ]. In the latter cases, new symptoms or abnormal data were found in sequence, which makes it easier to reach an early diagnosis and to provide treatment.…”