Diabetes mellitus associated with immune checkpoint inhibitor therapy, about 4 cases.

Abstract

Introduction: Monoclonal antibodies directed against the immune checkpoint (CPIs) have been improved the prognosis of some malignancies, however adverse events have been reported within them, diabetes mellitus induced by PCI (DM1-CPIs) is considered an infrequent affectation(2% prevalence),  presenting as insulin-dependent type 1(DM1) or worsering of diabetes mellitus  2 ( Dm2) .We present 4 clinical cases of previously normo-glycemic patients who after immunotherapy develop new-onset DM.

Discussion and conclusions:The diagnosis of DM-ICP is supported by clinical presentation, requirement of multiple doses of insulin, presence of positive anti-islet or anti-glutamic acid decarboxylase (GAD) antibodies, usually debuting as DKA,  low C-peptide levels, rapid onset over time, all in the presence of PCI that support the diagnostic suspicion.

Conclusion: These adverse events do not contraindicate the use of CPIs  but education is needed to suspect, diagnose and treat patients appropriately .