Metachronous immune-related adverse events involving type 1 diabetes and isolated adrenocorticotropic hormone deficiency associated with pembrolizumab monotherapy for metastatic head and neck cancer: a case report.
Diabetic ketoacidosis
Head and neck cancer
Immune checkpoint inhibitors
Pituitary
Recurrence/metastasis
Journal
Journal of medical case reports
ISSN: 1752-1947
Titre abrégé: J Med Case Rep
Pays: England
ID NLM: 101293382
Informations de publication
Date de publication:
12 Sep 2023
12 Sep 2023
Historique:
received:
04
01
2023
accepted:
30
07
2023
medline:
13
9
2023
pubmed:
12
9
2023
entrez:
12
9
2023
Statut:
epublish
Résumé
Immune checkpoint inhibitors might cause immune-related adverse events that are still largely unknown. An 80-year-old Asian female was diagnosed with cervical lymph node metastasis from lip cancer (cT1N0M0) and underwent right cervical neck dissection. Subsequently, she developed right cervical lymph node relapse and lung metastasis. The patient was deemed eligible for pembrolizumab owing to unresectable neck recurrence and pulmonary metastasis. The Combined Positive Score of the submandibular lymph nodes was 100. Pembrolizumab monotherapy was initiated, and complete remission was achieved. She developed diabetic ketoacidosis in the eighth month and was diagnosed with fulminant type 1 diabetes mellitus. Insulin induction was performed. The patient developed adrenal insufficiency after 10 months. These were immune-related adverse events, caused by pembrolizumab. The patient has remained in complete remission, and pembrolizumab therapy was continued. The study presents the first reported case of type 1 diabetes in a patient with head and neck squamous cell carcinoma treated with pembrolizumab monotherapy, in Japan. Efficient interdepartmental collaboration will promote the management of severe immune-related adverse events and improve the quality of life of patients.
Sections du résumé
BACKGROUND
BACKGROUND
Immune checkpoint inhibitors might cause immune-related adverse events that are still largely unknown.
CASE PRESENTATION
METHODS
An 80-year-old Asian female was diagnosed with cervical lymph node metastasis from lip cancer (cT1N0M0) and underwent right cervical neck dissection. Subsequently, she developed right cervical lymph node relapse and lung metastasis. The patient was deemed eligible for pembrolizumab owing to unresectable neck recurrence and pulmonary metastasis. The Combined Positive Score of the submandibular lymph nodes was 100. Pembrolizumab monotherapy was initiated, and complete remission was achieved. She developed diabetic ketoacidosis in the eighth month and was diagnosed with fulminant type 1 diabetes mellitus. Insulin induction was performed. The patient developed adrenal insufficiency after 10 months. These were immune-related adverse events, caused by pembrolizumab. The patient has remained in complete remission, and pembrolizumab therapy was continued.
CONCLUSIONS
CONCLUSIONS
The study presents the first reported case of type 1 diabetes in a patient with head and neck squamous cell carcinoma treated with pembrolizumab monotherapy, in Japan. Efficient interdepartmental collaboration will promote the management of severe immune-related adverse events and improve the quality of life of patients.
Identifiants
pubmed: 37697390
doi: 10.1186/s13256-023-04106-6
pii: 10.1186/s13256-023-04106-6
pmc: PMC10496339
doi:
Substances chimiques
pembrolizumab
DPT0O3T46P
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
387Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
González-Rodríguez E, Rodríguez-Abreu D. Immune checkpoint inhibitors: review and management of endocrine adverse events. Oncologist. 2016;21:804–16.
doi: 10.1634/theoncologist.2015-0509
pubmed: 27306911
pmcid: 4943391
Michot JM, Bigenwald C, Champiat S, Collins M, Carbonnel F, Postel-Vinay S, et al. Immune-related adverse events with immune checkpoint blockade: a comprehensive review. Eur J Cancer. 2016;54:139–48. https://doi.org/10.1016/j.ejca.2015.11.016 .
doi: 10.1016/j.ejca.2015.11.016
pubmed: 26765102
Kobayashi T, Iwama S, Arima H. Endocrine disruption caused by immune checkpoint inhibitors. Jpn J Diagn Treat. 2018;106:1127–32.
Iwama S, Arima H. Clinical practice and mechanism of endocrinological adverse events associated with immune checkpoint inhibitors. Nihon Rinsho Meneki Gakkai Kaishi. 2017;40:90–4. https://doi.org/10.2177/jsci.40.90 .
doi: 10.2177/jsci.40.90
pubmed: 28603206
Wang DY, Salem JE, Cohen JV, Chandra S, Menzer C, Ye F, et al. Fatal toxic effects associated with immune checkpoint inhibitors: a systematic review and meta-analysis. JAMA Oncol. 2018;4:1721–8. https://doi.org/10.1001/jamaoncol.2018.3923 .
doi: 10.1001/jamaoncol.2018.3923
pubmed: 30242316
pmcid: 6440712
Burtness B, Harrington KJ, Greil R, Soulières D, Tahara M, de Castro G, et al. Pembrolizumab alone or with chemotherapy versus cetuximab with chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-048): a randomised, open-label, phase 3 study. Lancet. 2019;394:1915–28. https://doi.org/10.1016/S0140-6736(19)32591-7 .
doi: 10.1016/S0140-6736(19)32591-7
pubmed: 31679945
Kojima T, Shah MA, Muro K, Francois E, Adenis A, Hsu CH, et al. Randomized phase III KEYNOTE-181 study of pembrolizumab versus chemotherapy in advanced esophageal cancer. J Clin Oncol. 2020;38:4138–48. https://doi.org/10.1200/JCO.20.01888 .
doi: 10.1200/JCO.20.01888
pubmed: 33026938
Caturegli P, Di Dalmazi G, Lombardi M, Grosso F, Larman HB, Larman T, et al. Hypophysitis secondary to cytotoxic T-lymphocyte-associated protein 4 blockade: insights into pathogenesis from an autopsy series. Am J Pathol. 2016;186:3225–35. https://doi.org/10.1016/j.ajpath.2016.08.020 .
doi: 10.1016/j.ajpath.2016.08.020
pubmed: 27750046
pmcid: 5225294
Iwama H, Arima H. Immune-related adverse events in pituitary glands. Jpn J Clin Exp Med. 2017;263:109–13.
Larkins E, Blumenthal G, Yuan W, He K, Sridhara R, Subramaniam S, et al. FDA approval summary: pembrolizumab for the treatment of recurrent or metastatic head and neck squamous cell carcinoma with disease progression on or after platinum-containing chemotherapy. Oncologist. 2017;22:873–8.
doi: 10.1634/theoncologist.2016-0496
pubmed: 28533473
pmcid: 5507654
Barroso-Sousa R, Barry WT, Garrido-Castro AC, Hodi FS, Min L, Krop IE, et al. Incidence of endocrine dysfunction following the use of different immune checkpoint inhibitor regimens: a systematic review and meta-analysis. JAMA Oncol. 2018;4:173–82. https://doi.org/10.1001/jamaoncol.2017.3064 .
doi: 10.1001/jamaoncol.2017.3064
pubmed: 28973656
Baden MY, Imagawa A, Abiru N, Awata T, Ikegami H, Uchigata Y, et al. Characteristics and clinical course of type 1 diabetes mellitus related to anti-programmed cell death-1 therapy. Diabetol Int. 2019;10:58–66. https://doi.org/10.1007/s13340-018-0362-2 .
doi: 10.1007/s13340-018-0362-2
pubmed: 30800564
Mukaida S, Adachi J, Otsubo N, Otsubo N, Matsuda Y, Tomii S, et al. An autopsy report of fulminant type 1 diabetes mellitus that developed during anti-programmed cell death-1 treatment. J Jpn Diabetes Soc. 2020;63:711–6.
Iijima H, Sakai A, Ebisumoto K, Murakami T, Maki D, Teramura T, et al. A study of patients with recurrent or metastatic head and neck cancer treated with pembrolizumab. Tokai J Exp Clin Med. 2022;47:99–104.
pubmed: 36073278
Freeman-Keller M, Kim Y, Cronin H, Richards A, Gibney G, Weber JS. Nivolumab in resected and unresectable metastatic melanoma: characteristics of immune-related adverse events and association with outcomes. Clin Cancer Res. 2016;22:886–94. https://doi.org/10.1158/1078-0432.CCR-15-1136 .
doi: 10.1158/1078-0432.CCR-15-1136
pubmed: 26446948