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

Abstract

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.

Pituitary-adrenal axis dysfunction induced by tislelizumab immunotherapy for non-small cell lung cancer: a case series and literature review

“…Several studies have suggested [ 10 , 12 , 13 ] that PD-1 and PD-L1 immune checkpoint inhibitors can cause adrenal insufficiency, which can be categorized as primary or secondary pituitary inflammation. Clinical symptoms of adrenal insufficiency include fatigue, nausea, and weakness.…”

“…During immunotherapy, irAEs in the endocrine system are common [ 12 ]. However, pituitary inflammation is relatively rare, especially in patients treated with PD-1 or PD-L1 alone [ 18 , 19 ].…”