A case of fulminant Type 1 diabetes following anti-PD1 immunotherapy in a genetically susceptible patient

M. Araújo, D. Ligeiro, L. Costa, F. Marques, H. Trindade, J.M. Correia, C. Fonseca

Research output: Contribution to journalArticlepeer-review

22 Citations (Scopus)

Abstract

Programmed cell death-1 protein (PD-1) is an immune checkpoint that has gained popularity in the treatment of several advanced cancers. Inhibiting this checkpoint is known to enhance immune response, but is also known to diminish immune tolerance and to increase autoimmune toxicity. We discuss a case of rapid onset fulminant Type 1 diabetes induced by treatment with anti-programmed cell death-1 monoclonal antibody, nivolumab, in a patient with late-stage non-small-cell lung adenocarcinoma. The patient had no history of previous diabetes but did reveal a high-risk genotype for Type 1 diabetes development (DR3-DQ2; DR4-DQ8). This finding supports that acute Type 1 diabetes can be an important adverse effect of immunotherapies targeting T-cell activation regulation. Because of the severity of this adverse effect, physicians should be aware of it, and studies directed to the detection of new biomarkers for early risk stratification (e.g., HLA) should be sought. © 2017 Future Medicine Ltd.
Original languageEnglish
Pages (from-to)531-535
Number of pages5
JournalImmunotherapy
Volume9
Issue number7
DOIs
Publication statusPublished - 2017

Keywords

  • alpha adrenergic receptor stimulating agent
  • angiotensin receptor antagonist
  • beta adrenergic receptor blocking agent
  • C peptide
  • C reactive protein
  • carboplatin
  • glutamate decarboxylase
  • hemoglobin A1c
  • hydroxymethylglutaryl coenzyme A reductase inhibitor
  • insulin
  • nivolumab
  • noradrenalin
  • pemetrexed
  • thiazide diuretic agent
  • acute kidney failure
  • aged
  • Article
  • cancer immunotherapy
  • cancer staging
  • capillary electrophoresis
  • case report
  • Caucasian
  • confusion
  • diabetic ketoacidosis
  • echography
  • female
  • hemodynamics
  • human
  • hyperglycemia
  • insulin dependent diabetes mellitus
  • insulin treatment
  • ketoacidosis
  • multiple cycle treatment
  • non small cell lung cancer
  • polydipsia
  • polymerase chain reaction
  • polyuria
  • priority journal
  • protein blood level
  • Sanger sequencing
  • urinalysis
  • vomiting

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