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Cancer Immunology, Immunotherapy

, Volume 66, Issue 1, pp 25–32 | Cite as

A case of pembrolizumab-induced type-1 diabetes mellitus and discussion of immune checkpoint inhibitor-induced type 1 diabetes

  • Young Kwang ChaeEmail author
  • Lauren Chiec
  • Nisha Mohindra
  • Ryan Gentzler
  • Jyoti Patel
  • Francis Giles
Original Article

Abstract

Immune checkpoint inhibitors such as pembrolizumab, ipilimumab, and nivolumab, now FDA-approved for use in treating several types of cancer, have been associated with immune-related adverse effects. Specifically, the antibodies targeting the programmed-cell death-1 immune checkpoint, pembrolizumab and nivolumab, have been rarely reported to induce the development of type 1 diabetes mellitus. Here we describe a case of a patient who developed antibody-positive type 1 diabetes mellitus following treatment with pembrolizumab in combination with systemic chemotherapy for metastatic adenocarcinoma of the lung. We will also provide a brief literature review of other rarely reported cases of type 1 diabetes presenting after treatment with pembrolizumab and nivolumab, as well as discussion regarding potential mechanisms of this adverse effect and its importance as these drugs continue to become even more widespread.

Keywords

Pembrolizumab Nivolumab Ipilimumab Diabetes mellitus Immunomodulatory Immune-related adverse effect 

Abbreviations

ALK

Anaplastic lymphoma kinase

CK

Cytokeratin

CT

Computed tomography

DKA

Diabetic ketoacidosis

EGFR

Epidermal growth factor receptor

GAD

Glutamic acid decarboxylase

HbA1c

Hemoglobin A1c

IA

Islet antigen

ICA

Islet cell autoantigen

KRAS

Kirsten rat sarcoma

NOD

Non-obese diabetic

NR

Not reported

NSCLC

Non-small cell lung cancer

PAX

Paired box gene

RCC

Renal cell carcinoma

SCLC

Small cell lung cancer

T1DM

Type 1 diabetes mellitus

Treg

Regulatory T cell

TTF

Thyroid transcription factor

UD

Undetectable

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Young Kwang Chae
    • 1
    • 2
    • 3
    Email author
  • Lauren Chiec
    • 3
  • Nisha Mohindra
    • 1
    • 2
    • 3
  • Ryan Gentzler
    • 4
  • Jyoti Patel
    • 2
    • 3
    • 5
  • Francis Giles
    • 1
    • 2
    • 3
  1. 1.Developmental Therapeutics Program of the Division of Hematology/OncologyNorthwestern UniversityChicagoUSA
  2. 2.Robert H. Lurie Comprehensive Cancer Center of Northwestern UniversityChicagoUSA
  3. 3.Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  4. 4.University of Virginia School of MedicineCharlottesvilleUSA
  5. 5.The University of Chicago MedicineChicagoUSA

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