School of Medicine, Lebanese American University, Byblos, Lebanon.
Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Am J Emerg Med. 2019 Feb;37(2):376.e1-376.e2. doi: 10.1016/j.ajem.2018.10.040. Epub 2018 Oct 21.
Immune checkpoint inhibitors are a new class of anticancer drugs recently approved by the US Food and Drug Administration (FDA) for the treatment of various malignancies. Pembrolizumab is an immune checkpoint inhibitor that targets the programmed cell death protein-1 (PD-1) receptor and blocks its interaction with programmed cell death ligand-1 (PD-L1) and programmed cell death ligand-2 (PD-L2). Pembrolizumab was first approved by the FDA in 2014 for the treatment of advanced melanoma and is currently approved for use in non-small cell lung cancer and several other neoplasms. Immune checkpoint inhibitors such as pembrolizumab have been reported to induce immune-mediated side effects, including type 1 diabetes mellitus in very rare cases (0.1% in clinical trials). Here, we report the case of a woman with no known history of diabetes who presented to our emergency department in a state of diabetic ketoacidosis within 3 weeks of receiving only a single dose of pembrolizumab therapy, and without any previous exposure to immunotherapy. This case of abrupt adult-onset type 1 diabetes mellitus is an example of the undesirable side effects that can emerge after only a brief exposure to an immune checkpoint inhibitor. Close monitoring of patients receiving immune checkpoint inhibitors is warranted for the early diagnosis and management of imminent and potentially life-threatening complications.
免疫检查点抑制剂是一类新型的抗癌药物，最近被美国食品和药物管理局（FDA）批准用于治疗各种恶性肿瘤。派姆单抗是一种免疫检查点抑制剂，针对程序性细胞死亡蛋白-1（PD-1）受体，并阻断其与程序性细胞死亡配体-1（PD-L1）和程序性细胞死亡配体-2（PD-L2）的相互作用。派姆单抗于 2014 年首次被 FDA 批准用于治疗晚期黑色素瘤，目前已被批准用于非小细胞肺癌和其他几种肿瘤的治疗。据报道，免疫检查点抑制剂如派姆单抗可引起免疫介导的副作用，包括非常罕见的 1 型糖尿病（临床试验中为 0.1%）。在这里，我们报告了一例女性病例，她在接受单次派姆单抗治疗后 3 周内出现糖尿病酮症酸中毒，且无任何先前免疫治疗史，并无已知糖尿病史。这种突发性成人发病 1 型糖尿病是在短暂接触免疫检查点抑制剂后出现不良副作用的一个例子。需要密切监测接受免疫检查点抑制剂治疗的患者，以早期诊断和管理潜在的危及生命的并发症。
