GirotraM_Revised Supplemental Material_Clean_cx01.pdf (1.48 MB)

Immune Checkpoint Inhibitor-Associated Diabetes Mellitus: A Single-Institution Experience

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posted on 13.10.2020 by David J. Byun, Rebecca Braunstein, Jessica Flynn, Junting Zheng, Robert A. Lefkowitz, Sarah Kanbour, Monica Girotra
OBJECTIVE

To characterize immune checkpoint inhibitor-associated diabetes mellitus (ICI-DM) in a single-institution case series.

DESIGN AND METHODS

Retrospective chart review of 18 patients with new-onset ICI-DM following anti-PD-1/anti-PD-L1 therapy for advanced carcinomas.

RESULTS

9/18 patients had diabetic ketoacidosis (median glucose: 27.92mmol/L; median glucose before presentation: 6.35mmol/L). Median C-peptide at ICI-DM diagnosis was low, and declined during follow-up. Median anti-PD-1/anti-PD-L1 duration before ICI-DM was 3.65 months (range 0.56-12.23). Time to ICI-DM onset was a median 1.4 months/3 ICI cycles and 6 months/10 cycles in those positive and negative for GAD65 autoantibodies, respectively. Time to ICI-DM onset was a median 2.5 months/3 ICI cycles and 4.8 months/8 cycles after anti-PD-L1 or anti-PD-1 therapy, respectively. Significant pancreatic atrophy was seen radiographically.

CONCLUSIONS

ICI-DM presents abruptly, appears irreversible, is characterized by pancreatic atrophy, and may occur both earlier following PD-L1 blockade compared to PD-1 inhibition and in those who have positive GAD65 autoantibodies.

Funding

The preparation of this study was supported in part by NIH/NCI Cancer Center Support Grant No. P30CA008748 to Memorial Sloan Kettering Cancer Center.

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