Li Min, Wu Chenchen, Liu Yan, Zhang Ranran, Yang Qingqing, Shi Zhaoming, Sun Weihua, Hu Xiaolei
Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui Province, People's Republic of China.
Diabetes Metab Syndr Obes. 2022 Apr 22;15:1253-1260. doi: 10.2147/DMSO.S353403. eCollection 2022.
Endocrine adverse reactions are one of the most common adverse reactions in the treatment of immune checkpoint inhibitors (ICIs), mainly involving the pituitary gland, pancreas, thyroid gland, adrenal gland and other glands, resulting in corresponding endocrine dysfunction. We report a 45-year-old man with non-small-cell lung cancer who developed hypophysitis 11 months after initiation of treatment with an anti-PD-L1/CTLA-4 bispecific antibody (KN046) that blocks both programmed death ligand-1 (PD-L1) and cytotoxic T-lymphocyte antigen-4 (CTLA-4), followed by regular oral replacement doses of prednisone and levothyroxine tablets. The patient was diagnosed with type 1 diabetes mellitus (T1DM) with diabetic ketoacidosis (DKA) 25 months after the start of immunotherapy, presenting with acute hyperglycemic symptoms, ketoacidosis, and negative diabetic autoantibodies. By describing a case of KN046 immunotherapy involving multiple endocrine glands and reviewing relevant literature, we were able to summarize the clinical characteristics of KN046 immunotherapy-induced endocrine system-related immune-related adverse events (irAEs) for use in early detection, diagnosis and treatment.
内分泌不良反应是免疫检查点抑制剂（ICI）治疗中最常见的不良反应之一，主要累及垂体、胰腺、甲状腺、肾上腺等腺体，导致相应的内分泌功能障碍。我们报告1例45岁非小细胞肺癌男性患者，在开始使用抗程序性死亡配体1（PD-L1）/细胞毒性T淋巴细胞相关抗原4（CTLA-4）双特异性抗体（KN046）治疗11个月后发生垂体炎，随后规律口服泼尼松和左甲状腺素片替代治疗。该患者在免疫治疗开始25个月后被诊断为1型糖尿病（T1DM）伴糖尿病酮症酸中毒（DKA），表现为急性高血糖症状、酮症酸中毒，且糖尿病自身抗体阴性。通过描述1例涉及多个内分泌腺体的KN046免疫治疗病例并复习相关文献，我们总结了KN046免疫治疗引起的内分泌系统相关免疫相关不良事件（irAE）的临床特征，以用于早期发现、诊断和治疗。
