First Department of Clinical Oncology, Theagenio Hospital, Thessaloniki, Greece.
Department of Endocrinology, Theagenio Hospital, Thessaloniki, Greece.
Curr Oncol. 2019 Feb;26(1):e111-e114. doi: 10.3747/co.26.4151. Epub 2019 Feb 1.
Cancer immunotherapy has been one of the highlights in the advancement of cancer care. Certain immune checkpoint inhibitors bind to PD-1 on T cells and mediate an antitumour immune response. Given that immune checkpoint inhibitors are becoming part of standard care, a new class of adverse events-immune-related adverse events-has emerged. Among them is endocrine toxicity, most commonly targeting the thyroid, pituitary, or adrenal glands. New-onset diabetes mellitus has been reported in fewer than 1% of patients. We present a patient with type 1 diabetes mellitus secondary to immunotherapy, together with an overview of the associated literature. Patients who develop type 1 diabetes mellitus experience a rapid course, and diabetic ketoacidosis is commonly the presenting symptom. Insulin is currently the treatment of choice; oral antidiabetics or corticosteroids do not assist in management. Several predictive factors are under investigation, but physician awareness and prompt management are key to a positive outcome.
癌症免疫疗法一直是癌症治疗进展的亮点之一。某些免疫检查点抑制剂与 T 细胞上的 PD-1 结合，并介导抗肿瘤免疫反应。鉴于免疫检查点抑制剂已成为标准治疗的一部分，一类新的不良反应——免疫相关不良反应——已经出现。其中包括内分泌毒性，最常见的靶器官是甲状腺、垂体或肾上腺。不到 1%的患者出现新发糖尿病。我们报告了 1 例继发于免疫治疗的 1 型糖尿病患者，并对相关文献进行了综述。发生 1 型糖尿病的患者病情进展迅速，糖尿病酮症酸中毒通常是首发症状。胰岛素是目前的治疗选择；口服降糖药或皮质类固醇激素无助于治疗。目前正在研究几个预测因素，但医生的认识和及时管理是取得良好结局的关键。
