Nivolumab‐induced autoimmune diabetes

Abstract

AbstractBackgroundAdvances in research on lung cancer treatment have extended to manipulating the immune system for cancer treatment. A new class of monoclonal antibodies, which inhibit the programmed cell death 1 (PD‐1)/PD‐ligand1 (PD‐L1) immune checkpoint alliance, is being used for treatment in lung cancer, especially in heavily pretreated patients. An example of this class is nivolumab. Here we report an incident of autoimmune diabetes thought to have been induced by nivolumab.Clinical detailsA 78‐year‐old woman with no prior history of diabetes presented to the emergency department (ED) with a 3‐day history of lethargy, anorexia, dyspnoea, polyuria and polydipsia, following her third treatment of nivolumab infusion for her metastatic lung cancer. Her pathology results and clinical symptoms were consistent with a diagnosis of diabetic ketoacidosis.OutcomesThe patient's symptoms resolved after interventions of the ED, medical and endocrinology teams. She was eventually discharged from the hospital with insulin for her diabetes. Despite good disease response, the patient declined further nivolumab treatment. Manipulation of the immune checkpoint molecules may disrupt immunologic haemostasis and lead to autoimmune‐like side effects. Similar adverse events have previously been reported with this drug class in the treatment of various cancers.ConclusionThis case report highlights a probable causal relationship between nivolumab and diabetes. The adverse effects associated with nivolumab may not be fully familiar to all. This case report serves to raise awareness among healthcare professionals about this rare nivolumab‐associated adverse effect.