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Deligiorgi MV, Trafalis DT. A Concerted Vision to Advance the Knowledge of Diabetes Mellitus Related to Immune Checkpoint Inhibitors. Int J Mol Sci 2023; 24:ijms24087630. [PMID: 37108792 PMCID: PMC10146255 DOI: 10.3390/ijms24087630] [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: 02/14/2023] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
The rubric of immune-related (ir) diabetes mellitus (DM) (irDM) encompasses various hyperglycemic disorders related to immune checkpoint inhibitors (ICPis). Beyond sharing similarities with conventional DM, irDM is a distinct, yet important, entity. The present narrative review provides a comprehensive overview of the literature regarding irDM published in major databases from January 2018 until January 2023. Initially considered rare, irDM is increasingly being reported. To advance the knowledge of irDM, the present review suggests a concerted vision comprising two intertwined aspects: a scientific-centered and a patient-centered view. The scientific-centered aspect addresses the pathophysiology of irDM, integrating: (i) ICPi-induced pancreatic islet autoimmunity in genetically predisposed patients; (ii) altered gut microbiome; (iii) involvement of exocrine pancreas; (iv) immune-related acquired generalized lipodystrophy. The patient-centered aspect is both nurtured by and nurturing the four pillars of the scientific-centered aspect: awareness, diagnosis, treatment, and monitoring of irDM. The path forward is a multidisciplinary initiative towards: (i) improved characterization of the epidemiological, clinical, and immunological profile of irDM; (ii) standardization of reporting, management, and surveillance protocols for irDM leveraging global registries; (iii) patient stratification according to personalized risk for irDM; (iv) new treatments for irDM; and (v) uncoupling ICPi efficacy from immunotoxicity.
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Affiliation(s)
- Maria V Deligiorgi
- Department of Pharmacology-Clinical Pharmacology Unit, Faculty of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Dimitrios T Trafalis
- Department of Pharmacology-Clinical Pharmacology Unit, Faculty of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Antonuzzo A, Calabrò F, Quaglino P, Roila F, Sebastiani GD, Spina F, Pasqualetti G, Cortinovis D, Tagliaferri E, Peri A, Presotto EM, Egidi MF, Giacomelli L, Farroni F, Di Maio M, De Luca E, Danova M, Scottè F, Jordan K, Bossi P. Immunotherapy in Underrepresented Populations of Patients with Cancer: Do We Have Enough Evidence at Present? A Focus on Patients with Major Viral Infections and Autoimmune Disorders. Oncologist 2020; 25:e946-e954. [PMID: 32181960 DOI: 10.1634/theoncologist.2020-0035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/21/2020] [Indexed: 12/12/2022] Open
Abstract
The safety and activity of immune checkpoint inhibitors have been characterized in interventional and observational studies. However, only small studies have specifically investigated these agents in patients who are excluded or underrepresented in clinical trials, frequently referred to as "special populations" or "underrepresented populations." These include older adults, those with dysregulated immune activation, patients with a compromised immune function, and those carrying major viral infections, lymphoproliferative diseases, and major organ dysfunctions. Therefore, there remains substantial uncertainty regarding the use of immune checkpoint inhibitors in these specific settings. The Network of Italian Supportive Care in Oncology has carried out a multidisciplinary project, with the contribution of oncologists and other specialists, to retrieve the existing evidence on the use of immunotherapy in patients with solid and hematological cancers with the final aim to provide an expert guidance. The results of this effort are presented in this article, which is focused on patients with major viral infections or those with immune dysregulation/autoimmune diseases, and could be useful to guide decisions in clinical practice and to design prospective clinical trials focusing on the use of immunotherapy in these populations. IMPLICATIONS FOR PRACTICE: Substantial uncertainty remains regarding the use of immune checkpoint inhibitors in "underrepresented" patients, such as older adults, those with dysregulated immune activation, and patients with a compromised immune function, major viral infections, lymphoproliferative diseases or major organ dysfunctions. The Network of Italian Supportive Care in Oncology has carried out a multidisciplinary project to retrieve the existing evidence on the use of immunotherapy in underrepresented patients with cancer in order provide an expert guidance. The results of this effort, with a focus on patients with major viral infections or those with immune dysregulation/autoimmune diseases, are presented in this article and could be useful to guide decisions both in clinical practice and to design clinical trials.
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Affiliation(s)
- Andrea Antonuzzo
- UO Oncologia 1 SSN Polo Oncologico, Ambulatorio Terapie di Supporto, Pisa, Italy
| | | | - Pietro Quaglino
- Dermatologic Clinic, Department of Medical Sciences, Turin, Italy
| | - Fausto Roila
- Department of Medical Oncology, Azienda Ospedaliera, Universitaria Perugia, Italy
| | - Gian Domenico Sebastiani
- Unità Operativa Complessa di Reumatologia, Ospedale di Alta Specializzazione "San Camillo,", Rome, Italy
| | - Francesco Spina
- Division of Hematology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale Tumori, Milan, Italy
| | | | | | | | - Alessandro Peri
- Sodium Unit, Endocrinology, Department of Experimental and Clinical Biomedical Sciences, Mario Serio, University of Florence, Careggi Hospital, Florence, Italy
| | - Elena Margherita Presotto
- Sodium Unit, Endocrinology, Department of Experimental and Clinical Biomedical Sciences, Mario Serio, University of Florence, Careggi Hospital, Florence, Italy
| | | | - Luca Giacomelli
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
- Polistudium SRL, Milan, Italy
| | - Ferruccio Farroni
- Gastroenterology Department, Foligno Hospital, Unità Sanitaria Locale Umbria 2, Foligno, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Turin, Italy
- Division of Medical Oncology, Azienda Ospedaliero Ordine Mauriziano Hospital, Turin, Italy
| | - Emmanuele De Luca
- Department of Oncology, University of Turin, Turin, Italy
- Division of Medical Oncology, Azienda Ospedaliero Ordine Mauriziano Hospital, Turin, Italy
| | - Marco Danova
- Department of Internal Medicine and Medical Oncology, Vigevano Civic Hospital, Azienda Socio Sanitaria Territoriale (ASST) of Pavia, Pavia, Italy
| | - Florian Scottè
- Medical Oncology and Supportive Care Department, Hôpital Foch, Suresnes, France
| | - Karin Jordan
- Leitende Oberärztin, Klinik für Hämatologie, Onkologie und Rheumatologie, Innere Medizin V, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Paolo Bossi
- Medical Oncology, University of Brescia, ASST-Spedali Civili, Brescia, Italy
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