Fischer Matan, Amos Shoshana, Levy Ludmilla, Pollack Rena
Department of Endocrinology and Metabolism, Hadassah - Hebrew University Medical Center, Jerusalem, Israel.
Department of Internal Medicine, Internal Medicine B, Hadassah Medical Center, Jerusalem, Israel.
Harefuah. 2021 Oct;160(10):657-662.
Immune checkpoint inhibitors (ICIs) have transformed the care of cancer patients, providing therapeutic options for advanced malignancies considered otherwise untreatable. However, these agents have been associated with immune-related adverse events (irAEs). ICI-induced diabetes (ICI-DM) is a rare complication of programmed death-1 (PD-1) or programmed death-ligand 1 (PD-L1) inhibitor therapy (~1%) and can be life-threatening, as patients often present with severe hyperglycemia and in diabetic ketoacidosis. We describe two patients with rapid-onset diabetes mellitus associated with anti PD-1 therapy followed by an in-depth review of the literature. We discuss the clinical presentation, potential mechanisms and optimal management of patients with ICI-DM. As ICI use continues to expand across a wide variety of malignancies, clinicians must be aware of this potentially life-threatening irAE to prevent significant morbidity and mortality.
免疫检查点抑制剂(ICIs)已经改变了癌症患者的治疗方式,为那些原本被认为无法治疗的晚期恶性肿瘤提供了治疗选择。然而,这些药物与免疫相关不良事件(irAEs)有关。ICI诱导的糖尿病(ICI-DM)是程序性死亡-1(PD-1)或程序性死亡配体1(PD-L1)抑制剂治疗的一种罕见并发症(约1%),可能危及生命,因为患者常表现为严重高血糖和糖尿病酮症酸中毒。我们描述了两名与抗PD-1治疗相关的快速发作糖尿病患者,并对文献进行了深入回顾。我们讨论了ICI-DM患者的临床表现、潜在机制和最佳管理方法。随着ICI在各种恶性肿瘤中的应用不断扩大,临床医生必须意识到这种潜在的危及生命的irAE,以预防严重的发病和死亡。