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Anti-PD-L1 atezolizumab-Induced Autoimmune Diabetes: a Case Report and Review of the Literature

  • Therapy in Practice
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Abstract

Programmed cell death-1 and programmed death ligand 1 (PD-1/PD-L1) inhibitors trigger an immune-mediated anti-tumour response by promoting the activation of cytotoxic T lymphocytes. Although proven to be highly effective in the treatment of several malignancies they can induce significant immune-related adverse events (irAEs) including endocrinopathies, most commonly hypophysitis and thyroid dysfunction, and rarely autoimmune diabetes. Here we present the first case report of a patient with a primary diagnosis of urothelial cancer developing PD-L1 inhibitor-induced autoimmune diabetes. A euglycemic 57 year old male presented to clinic with dehydration after the fifth cycle of treatment with the novel PD-L1 inhibitor atezolizumab. Blood tests demonstrated rapid onset hyperglycaemia (BM 24 mmol/L), ketosis and a low C-peptide level (0.65 ng/mL) confirming the diagnosis of type 1 diabetes. He responded well to insulin therapy and was discharged with stable blood glucose levels. Due to the widening use of PD-1/PD-L1 inhibitors in cancer treatment clinicians need to be aware of this rare yet treatable irAE. Given the morbidity and mortality associated with undiagnosed autoimmune diabetes we recommend routine HbA1c and plasma glucose testing in all patients prior to and during treatment with PD-1/PD-L1 inhibitors until more evidence has accumulated on identifying those patients with a pre-treatment risk of such irAEs.

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Authors and Affiliations

  1. Department of Oncology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK

    Laura Hickmott, Hugo De La Peña & Andrew Protheroe

  2. Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK

    Helen Turner, Fathelrahman Ahmed & Ashley Grossman

  3. Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, M20 4BX, UK

    Avinash Gupta

Authors
  1. Laura Hickmott
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  2. Hugo De La Peña
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  3. Helen Turner
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  4. Fathelrahman Ahmed
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  5. Andrew Protheroe
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  6. Ashley Grossman
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  7. Avinash Gupta
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Correspondence to Laura Hickmott.

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Conflict of Interest

Andrew Protheroe has received research funding from MERCK as part of their global investment programme, honoraria from Ipsen, Bayer, Astellas and Janssen, received financial support from Bristol-Myers Squibb and payment for speakers fees from Janssen and Astellas. Avinash Gupta has received honoraria and financial support from Bristol-Myers Squibb. The rest of the authors have no conflicts of interests to disclose.

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Hickmott, L., De La Peña, H., Turner, H. et al. Anti-PD-L1 atezolizumab-Induced Autoimmune Diabetes: a Case Report and Review of the Literature. Targ Oncol 12, 235–241 (2017). https://doi.org/10.1007/s11523-017-0480-y

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  • DOI: https://doi.org/10.1007/s11523-017-0480-y

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