期刊
DIABETES
卷 67, 期 8, 页码 1471-1480出版社
AMER DIABETES ASSOC
DOI: 10.2337/dbi18-0002
关键词
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资金
- National Institute of Diabetes and Digestive and Kidney Diseases [R01 DK057846, UC4 DK116290]
- Leona M. and Harry B. Helmsley Charitable Trust [2018PG-T1D059]
- JDRF
Insulin-dependent diabetes may occur in patients with cancers who are treated with checkpoint inhibitors (CPIs). Wereviewed cases occurring over a 6-year period at two academic institutions and identified 27 patients in whom this developed, or an incidence of 0.9%. The patients had a variety of solid-organ cancers, but all had received either anti-PD-1 or anti-PD-L1 antibodies. Diabetes presented with ketoacidosis in 59%, and 42% had evidence of pancreatitis in the peridiagnosis period. Forty percent had at least one positive autoantibody and 21% had two or more. There was a predominance of HLA-DR4, which was present in 76% of patients. Other immune adverse events were seen in 70%, and endocrine adverse events in 44%. We conclude that autoimmune, insulin-dependent diabetes occurs in close to 1% of patients treated with anti-PD-1 or -PD-L1 CPIs. This syndrome has similarities and differences compared with classic type 1 diabetes. The dominance of HLA-DR4 suggests an opportunity to identify those at highest risk of these complications and to discover insights into the mechanisms of this adverse event.
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