Collateral Damage: Insulin-Dependent Diabetes Induced With Checkpoint Inhibitors.
Diabetes
; 67(8): 1471-1480, 2018 08.
Article
em En
| MEDLINE
| ID: mdl-29937434
ABSTRACT
Insulin-dependent diabetes may occur in patients with cancers who are treated with checkpoint inhibitors (CPIs). We reviewed 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.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Pancreatite
/
Doenças Autoimunes
/
Modelos Imunológicos
/
Diabetes Mellitus Tipo 1
/
Antígeno B7-H1
/
Receptor de Morte Celular Programada 1
/
Antineoplásicos Imunológicos
Tipo de estudo:
Etiology_studies
Idioma:
En
Revista:
Diabetes
Ano de publicação:
2018
Tipo de documento:
Article