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Marsiglio J, McPherson JP, Kovacsovics-Bankowski M, Jeter J, Vaklavas C, Swami U, Grossmann D, Erickson-Wayman A, Soares HP, Kerrigan K, Gibson B, Doherty JA, Hyngstrom J, Hardikar S, Hu-Lieskovan S. A single center case series of immune checkpoint inhibitor-induced type 1 diabetes mellitus, patterns of disease onset and long-term clinical outcome. Front Immunol 2023; 14:1229823. [PMID: 37671166 PMCID: PMC10475559 DOI: 10.3389/fimmu.2023.1229823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 08/01/2023] [Indexed: 09/07/2023] Open
Abstract
Background Type 1 diabetes mellitus (T1DM) is a rare, but serious immune-related adverse event (irAE) of immune checkpoint inhibitors (ICIs). Our goal was to characterize treatment outcomes associated with ICI-induced T1DM through analysis of clinical, immunological and proteomic data. Methods This was a single-center case series of patients with solid tumors who received ICIs and subsequently had a new diagnosis of T1DM. ICD codes and C-peptide levels were used to identify patients for chart review to confirm ICI-induced T1DM. Baseline blood specimens were studied for proteomic and immunophenotypic changes. Results Between 2011 and 2023, 18 of 3744 patients treated at Huntsman Cancer Institute with ICIs were confirmed to have ICI-induced T1DM (0.48%). Eleven of the 18 patients received anti-PD1 monotherapy, 4 received anti-PD1 plus chemotherapy or targeted therapy, and 3 received ipilimumab plus nivolumab. The mean time to onset was 218 days (range 22-418 days). Patients had sudden elevated serum glucose within 2-3 weeks prior to diagnosis. Sixteen (89%) presented with diabetic ketoacidosis. Three of 12 patients had positive T1DM-associated autoantibodies. All patients with T1DM became insulin-dependent through follow-up. At median follow-up of 21.9 months (range 8.4-82.4), no patients in the melanoma group had progressed or died from disease. In the melanoma group, best responses were 2 complete response and 2 partial response while on active treatment; none in the adjuvant group had disease recurrence. Proteomic analysis of baseline blood suggested low inflammatory (IL-6, OSMR) markers and high metabolic (GLO1, DXCR) markers in ICI-induced T1DM cohort. Conclusions Our case series demonstrates rapid onset and irreversibility of ICI-induced T1DM. Melanoma patients with ICI-induced T1DM display excellent clinical response and survival. Limited proteomic data also suggested a unique proteomic profile. Our study helps clinicians to understand the unique clinical presentation and long-term outcomes of this rare irAE for best clinical management.
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Affiliation(s)
- John Marsiglio
- Department of Internal Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Jordan P. McPherson
- Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT, United States
| | | | - Joanne Jeter
- Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT, United States
| | - Christos Vaklavas
- Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT, United States
| | - Umang Swami
- Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT, United States
| | - Douglas Grossmann
- Department of Dermatology, University of Utah Health, Salt Lake City, UT, United States
| | | | - Heloisa P. Soares
- Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT, United States
| | - Katie Kerrigan
- Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT, United States
| | - Berit Gibson
- Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT, United States
| | - Jennifer Anne Doherty
- Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT, United States
| | - John Hyngstrom
- Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT, United States
| | - Sheetal Hardikar
- Department of Population Health Sciences, University of Utah Health, Salt Lake City, UT, United States
| | - Siwen Hu-Lieskovan
- Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT, United States
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Chan JSK, Lee S, Kong D, Lakhani I, Ng K, Dee EC, Tang P, Lee YHA, Satti DI, Wong WT, Liu T, Tse G. Risk of diabetes mellitus among users of immune checkpoint inhibitors: A population-based cohort study. Cancer Med 2023; 12:8144-8153. [PMID: 36647331 PMCID: PMC10134274 DOI: 10.1002/cam4.5616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/12/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) are increasingly established cancer therapeutics, but they are associated with new-onset diabetes mellitus (DM). Such risks have not been adequately quantified, and between-class and -sex differences remain unexplored. METHODS This was a prospective cohort study of cancer patients receiving any ICI in Hong Kong between 2013 and 2021. Patients with known DM were excluded. Due to few patients using other ICIs, only programmed cell death 1 inhibitors (PD-1i) and programmed death ligand 1 inhibitors (PD-L1i) were compared, alongside between-sex comparison. When comparing PD-1i against PD-L1i, patients with the use of other ICIs or both PD-1i and PD-L1 were further excluded. Inverse probability treatment weighting (IPTW) was used to minimize between-group covariate imbalances. RESULTS Altogether, 3375 patients were analyzed (65.2% males, median age 62.2 [interquartile range 53.8-69.5] years old). Over a median follow-up of 1.0 [0.4-2.4] years, new-onset DM occurred in 457 patients (13.5%), with a 3-year risk of 14.5% [95% confidence interval 13.3%, 15.8%]. IPTW achieve acceptable covariate balance between sexes, and between PD-1i (N = 622) and PD-L1i (N = 2426) users. Males had significantly higher risk of new-onset DM (hazard ratio 1.35 [1.09, 1.67], p = 0.006), while PD-1i and PD-L1i users did not have significantly different risks (hazard ratio vs PD-L1i 0.81 [0.59, 1.11], p = 0.182). These were consistent in those with at least 1 year of follow-up, and on competing risk regression. CONCLUSION Users of ICI may have a substantial risk of new-onset DM, which may be higher in males but did not differ between PD-1i and PD-L1i.
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Affiliation(s)
| | - Sharen Lee
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, Hong Kong, China
| | - Dicken Kong
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, Hong Kong, China
| | - Ishan Lakhani
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, Hong Kong, China
| | - Kenrick Ng
- Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Pias Tang
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, Hong Kong, China
| | - Yan Hiu Athena Lee
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, Hong Kong, China
| | - Danish Iltaf Satti
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, Hong Kong, China
| | - Wing Tak Wong
- School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.,Kent and Medway Medical School, University of Kent and Canterbury Christ Church University, Canterbury, Kent, UK.,School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
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Lv C, Wu C, Zhang Y, Li W, Wang X, Liang L. Sintilimab-Induced Diabetic Ketoacidosis in a Patient with Radiation and Multichemorefractory Penile Cancer: A Case Report and Literature Review. Curr Oncol 2022; 29:7987-7993. [PMID: 36354692 PMCID: PMC9688826 DOI: 10.3390/curroncol29110632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/12/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
Penile squamous cell carcinoma (PSCC) is a rare disease. The treatment options for advanced penile cancer are often limited, and the prognosis remains poor. We reported a 52-year-old male recurrent and metastatic PSCC patient with high PD-L1 expression (90%) and TMB (14.4 muts/Mb). He had undergone penectomy, bilateral inguinal lymph node dissection, and excision of the abdominal wall mass. Despite cisplatin-based concurrent chemoradiotherapy and sequential chemotherapy with docetaxel plus cisplatin then being carried out, the carcinoma still progressed. The patient then obtained progression-free survival with continuous sintilimab, although he experienced the new onset of ICI-induced diabetes after 24 cycles of sintilimab and required sustained insulin treatment. He had negative type 1 diabetes-associated autoantibodies and the susceptible HLA genotype DR3-DQ2 haplotype. This is the first patient with radiation and multichemorefractory PSCC who has obtained the remarkable anti-tumor effect of partial regression exceeding 32 months during continuous sintilimab and anlotinib treatment.
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Affiliation(s)
- Chuan Lv
- Department of Endocrinology, People’s Hospital of China Medical University, The People’s Hospital of Liaoning Province, Shenyang 110016, China
| | - Can Wu
- Endoscopy Department, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Yan Zhang
- Department of Ophthalmology, Shenyang Tenth People’s Hospital, Shenyang 110044, China
| | - Wendong Li
- Radiology Department, People’s Hospital of China Medical University, Shenyang 110016, China
| | - Xuesong Wang
- Department of Urology, People’s Hospital of China Medical University, Shenyang 110016, China
| | - Li Liang
- Department of Endocrinology, People’s Hospital of China Medical University, The People’s Hospital of Liaoning Province, Shenyang 110016, China
- Correspondence:
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Fattizzo B, Rampi N, Barcellini W. Hematological and Extra-Hematological Autoimmune Complications after Checkpoint Inhibitors. Pharmaceuticals (Basel) 2022; 15:ph15050557. [PMID: 35631383 PMCID: PMC9143083 DOI: 10.3390/ph15050557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 02/04/2023] Open
Abstract
Checkpoint inhibitors (CPI) represent a novel therapeutical strategy with a high efficacy both in solid and hematological cancers. They act by reactivating the immune system against neoplastic cells but may, in turn, cause immune-related adverse events (IRAEs) involving several organs with variable frequency and severity. Up to 10% of CPI-treated patients experience hematological IRAEs, mainly cytopenias. The differential diagnosis is challenging due to underlying disease, previous treatments and the variable liability of available tests (i.e., the direct antiglobulin test, anti-platelet antibodies, etc.). Among extra-hematological IRAEs, cutaneous and endocrine ones are the most frequent (up to 30–50%), ranging from mild (pruritus, eczema and thyroid dysfunctions) to severe forms (bullous disorders, hypophysitis and diabetes), mostly requiring topic or replacement therapy. Gastroenteric and kidney toxicities occur in about 5% of patients, biopsies may support the diagnosis, and immunosuppressive treatment is required in severe cases. Finally, neurologic and cardiologic IRAEs, although rare, may be life-threatening and require prompt intervention. By reviewing the most recent literature on post-CPI IRAEs, it emerged that clinical suspicion and monitoring of laboratory markers of organ damage is pivotal to a prompt diagnosis. In severe cases, CPI should be discontinued and immunosuppressive therapy started, whilst rechallenge is anecdotal and should be carefully evaluated.
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Affiliation(s)
- Bruno Fattizzo
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (N.R.); (W.B.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-0255033477
| | - Nicolò Rampi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (N.R.); (W.B.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Wilma Barcellini
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (N.R.); (W.B.)
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