Immune-Mediated Diabetes Induced by Dostarlimab: A Case Report
DOI:
https://doi.org/10.20344/amp.23618Keywords:
Diabetes Mellitus, Type 1/chemically induced, Endocrine System Diseases, Immune Checkpoint InhibitorsAbstract
Immune checkpoint inhibitors (ICI), particularly antibodies targeting programmed death receptor-1 (PD-1) and its ligand, programmed death-ligand 1, have been rarely associated with the development of immune-mediated diabetes mellitus. To the best of our knowledge, we report the first published case of immune-mediated diabetes mellitus associated with dostarlimab—a monoclonal antibody targeting PD-1—in a 78-year-old woman diagnosed with endometrial adenocarcinoma and persistent peritoneal disease. Following six cycles of dostarlimab, she presented with diabetic ketoacidosis. Despite negative autoimmune antibodies, her relatively low HbA1c and C-peptide levels together with her clinical presentation were highly suggestive of ICI-induced diabetes mellitus. Following stabilization with intravenous fluids and insulin infusion, she was transitioned to a basal-bolus insulin regimen. Dostarlimab was discontinued, and restaging showed resolution of peritoneal disease. This case emphasizes the importance of early detection and management of ICI-induced diabetes mellitus.
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Onishchenko R, Nasser N, Mitra A. Immune checkpoint inhibitors in the emergency department. Acad Med Surg. 2024 (in press). doi:10.62186/001c.124781. DOI: https://doi.org/10.62186/001c.124781
Yang L, Murthy S, Cortellini A, Lim EA, Gonzalez M, Pinato DJ, et al. Effects of immune checkpoint inhibitor associated endocrinopathies on cancer survival. Front Endocrinol. 2024;15:1369268. DOI: https://doi.org/10.3389/fendo.2024.1369268
Kyriacou A, Melson E, Chen W, Kempegowda P. Is immune checkpoint inhibitor-associated diabetes the same as fulminant type 1 diabetes mellitus? Clin Med. 2020;20:417-23. DOI: https://doi.org/10.7861/clinmed.2020-0054
GSK. RUBY efficacy & study design. 2024. [cited 2025 Jan 15]. Available from: https://www.jemperlihcp.com/efficacy/ruby-trial/.
Mirza MR, Chase DM, Slomovitz BM, dePont Christensen R, Novák Z, Black D, et al. Dostarlimab for primary advanced or recurrent endometrial cancer. N Engl J Med. 2023;388:2145-58. DOI: https://doi.org/10.1056/NEJMoa2216334
Irani AZ, Almuwais A, Gibbons H. Immune checkpoint inhibitor–induced diabetes mellitus with pembrolizumab. BMJ Case Rep. 2022;15:e245846. DOI: https://doi.org/10.1136/bcr-2021-245846
Liao D, Liu C, Chen S, Liu F, Li W, Shangguan D, et al. Recent advances in immune checkpoint inhibitor-induced type 1 diabetes mellitus. Int Immunopharmacol. 2023;122:110414. DOI: https://doi.org/10.1016/j.intimp.2023.110414
Zhou L, Yang S, Li Y, Xue C, Wan R. A comprehensive review of immune checkpoint inhibitor-related diabetes mellitus: incidence, clinical features, management, and prognosis. Front Immunol. 2024;15:1448728. DOI: https://doi.org/10.3389/fimmu.2024.1448728
Akturk HK, Michels AW. Adverse events associated with immune checkpoint inhibitors: a new era in autoimmune diabetes. Curr Opin Endocrinol Diabetes Obes. 2020;27:187-93. DOI: https://doi.org/10.1097/MED.0000000000000546
Haanen JB, Obeid M, Spain L, Carbonnel F, Wang Y, Robert C, et al. Management of toxicities from immunotherapy: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022;33:1217-38. DOI: https://doi.org/10.1016/j.annonc.2022.10.001
Venetsanaki V, Boutis A, Chrisoulidou A, Papakotoulas P. Diabetes mellitus secondary to treatment with immune checkpoint inhibitors. Curr Oncol. 2019;26:e111. DOI: https://doi.org/10.3747/co.26.4151
Kapke J, Shaheen Z, Kilari D, Knudson P, Wong S. Immune checkpoint inhibitor-associated type 1 diabetes mellitus: case series, review of the literature, and optimal management. Case Rep Oncol. 2018;10:897-909. DOI: https://doi.org/10.1159/000480634
Schneider BJ, Naidoo J, Santomasso BD, Lacchetti C, Adkins S, Anadkat M, et al. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: ASCO guideline update. J Clin Oncol. 2021;39:4073-126. DOI: https://doi.org/10.1200/JCO.21.01440
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