Kikuchi Fumi, Saheki Takanobu, Imachi Hitomi, Kobayashi Toshihiro, Fukunaga Kensaku, Ibata Tomohiro, Sato Seisuke, Ban Natsuki, Lyu Jingya, Japar Salimah, Murao Koji
Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, 1750-1, Miki-cho, Kita-gun, Takamatsu, Kagawa, 761-0793, Japan.
Department of Internal Medicine, Sanuki Municipal Hospital, 387-1, Sangawa-cho, Sanuki, Kagawa, 769-2393, Japan.
J Med Case Rep. 2021 Apr 23;15(1):214. doi: 10.1186/s13256-020-02656-7.
Immune checkpoint inhibitors have recently become widely used for the management of advanced cancer patients. During the development of immune checkpoint inhibitors (ICPIs), it was quickly recognized that they are associated with autoimmune or autoinflammatory side effects. These toxicities are known as immune-related adverse events (irAEs): common endocrine irAEs include hypophysitis and thyroid dysfunction, and uncommon irAEs include type 1 diabetes mellitus (T1DM).
A 62-year-old Japanese man with metastatic renal cell carcinoma was treated with sunitinib followed by the 10th cycle of treatment with the ICPI nivolumab. He had already had thyroiditis and hypophysitis due to these anti-cancer drugs. On admission, he showed an extremely elevated plasma glucose level (601 mg/dl) and a low C-peptide level, and was diagnosed with acute T1DM. The patient was treated with intravenous fluid infusion and continuous insulin infusion. On the second day, he was switched to multiple daily injections of insulin therapy. Since these treatments, his blood glucose levels have been stable and he has been treated with an additional 10 ICPI treatments for renal cell carcinoma for over a year.
Treatment with ICPIs is expected to increase in the future. There may be cases in which their use for cancer treatment is inevitable despite the side effects. As long as treatment with ICPI continues, multiple side effects can be expected in some cases. It is important to carefully observe the side effects that occur during ICPI treatment and to provide appropriate treatment for each side effect.
免疫检查点抑制剂最近已广泛用于晚期癌症患者的治疗。在免疫检查点抑制剂（ICPI）的研发过程中，人们很快认识到它们与自身免疫或自身炎症性副作用有关。这些毒性被称为免疫相关不良事件（irAE）：常见的内分泌irAE包括垂体炎和甲状腺功能障碍，不常见的irAE包括1型糖尿病（T1DM）。
一名62岁的日本转移性肾细胞癌男性患者，先用舒尼替尼治疗，随后接受ICPI纳武单抗的第10个疗程治疗。由于这些抗癌药物，他已经患有甲状腺炎和垂体炎。入院时，他的血浆葡萄糖水平极高（601mg/dl），C肽水平低，被诊断为急性T1DM。患者接受了静脉输液和持续胰岛素输注治疗。第二天，改为每日多次注射胰岛素治疗。自这些治疗以来，他的血糖水平一直稳定，并且已经接受了另外10次针对肾细胞癌的ICPI治疗，持续了一年多。
预计未来ICPI的治疗应用会增加。尽管存在副作用，但在某些情况下，其用于癌症治疗可能是不可避免的。只要继续使用ICPI治疗，在某些情况下可能会出现多种副作用。仔细观察ICPI治疗期间出现的副作用并针对每种副作用提供适当的治疗非常重要。
