A 60-year-old Japanese man, with no medical or family history of diabetes, presented with acute-onset type 1 diabetes following nivolumab treatment for advanced non-small-cell lung cancer. During cycle 35 of nivolumab therapy, his glycated hemoglobin level increased from 7.6% to 9.1% in one month. Test results for islet-related and anti-thyroid peroxidase antibodies were negative. A glucagon tolerance test showed insulin dependency. Type 1 diabetes after anti-programmed death-ligand 1 antibody administration is an immune-related adverse event, and numerous reports suggest that fulminant type 1 diabetes can develop in these patients. However, there are few reports of acute-onset type 1 diabetes mellitus.
BrahmerJReckampKLBaasP, et al.Nivolumab versus docetaxel in advanced squamous-cell non-small-cell lung cancer. N Engl J Med2015; 373: 1627–1639.
2.
HerbstRSBaasPKimDW, et al.Pembrolizumab versus docetaxel for previously treated, PD-L1 positive, advanced non-small-cell lung cancer (KEYNOTE-010): a randomised controlled trial. Lancet2016; 387: 1540–1550.
3.
MotzerRJEscudierBMcDermottDF, et al.Nivolumab versus everolimus in advanced renal-cell carcinoma. N Engl J Med2015; 373: 1803–1813.
4.
LarkinJChiarion-SileniVGonzalezR, et al.Combined nivolumab and ipilimumab or monotherapy in untreated melanoma. N Engl J Med2015; 373: 23–34.
5.
SuQZhangXCWangDY, et al.The risk of immune-related endocrine disorders associated with anti-PD-1 inhibitors therapy for solid tumors: a systematic review and meta-analysis. Int Immunopharmacol2018; 59: 328–338.
6.
WangPFChenYSongSY, et al.Immune-related adverse events associated with anti-PD-1/PD-L1 treatment for malignancies: a meta-analysis. Front Pharmacol2017; 8: 730.
KapkeJShaheenZKilariD, et al.Immune checkpoint inhibitor-associated type 1 diabetes mellitus: case series, review of the literature, and optimal management. Case Rep Oncol2017; 10: 897–909.
9.
SakuraiKNiitsumaSSatoR, et al.Painless thyroiditis and fulminant type 1 diabetes mellitus in a patient treated with an immune checkpoint inhibitor, nivolumab. Tohoku J Exp Med2018; 244: 33–40.
10.
American Diabetes Association. 2 Classification and diagnosis of diabetes: standards of medical care in diabetes-2018. Diabetes Care2018; 41: S13–S27.
LenschowDJWalunasTLBluestoneJA. CD28/B7 system of T cell costimulation. Annu Rev Immunol1996; 14: 233–258.
13.
ImagawaAHanafusaTMiyagawaJ, et al.A novel subtype of type 1 diabetes mellitus characterized by a rapid onset and an absence of diabetes-related antibodies. Osaka IDDM Study Group. N Engl J Med2000; 342: 301–307.
14.
StenströmGGottsäterABakhtadzeE, et al.Latent autoimmune diabetes in adults: definition, prevalence, beta-cell function, and treatment. Diabetes2005; 54(Suppl 2): S68–S72.
15.
SakaiGSaitoDNakajimaR, et al.Intrinsic insulin secretion capacity might be preserved by discontinuing anti-programmed cell death protein 1 antibody treatment in ‘anti-programmed cell death protein 1 antibody-induced’ fulminant type 1 diabetes. J Diabetes Investig2018; 9: 448–449.
16.
OkamotoMOkamotoMGotohK, et al.Fulminant type 1 diabetes mellitus with anti-programmed cell death-1 therapy. J Diabetes Investig2016; 7: 915–918.
17.
TzoulisPCorbettRWPonnampalamS, et al.Nivolumab-induced fulminant diabetic ketoacidosis followed by thyroiditis. Endocrinol Diabetes Metab Case Rep2018; 2018: 18–0111.
18.
KawasakiEMaruyamaTImagawaA, et al.Diagnostic criteria for acute-onset type 1 diabetes mellitus (2012): Report of the Committee of Japan Diabetes Society on the research of fulminant and acute-onset type 1 diabetes mellitus. J Diabetes Investig2014; 5: 115–118.
19.
ShieldsBMPetersJLCooperC, et al.Can clinical features be used to differentiate type 1 from type 2 diabetes? A systematic review of the literature. BMJ Open2015; 5: e009088.
20.
NaranjoCABustoUSellersEM. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther1981; 30: 239–245.
21.
RibasAPuzanovIDummerR, et al.Pembrolizumab versus investigator-choice chemotherapy for ipilimumab-refractory melanoma (KEYNOTE-002): a randomised, controlled, phase 2 trial. Lancet Oncol2015; 16: 908–918.
22.
Spigel D, McLeod M, Hussein M, et al. Randomized results of fixed‐duration (1‐yr) vs continuous nivolumab in patients (pts) with advanced non‐small cell lung cancer (NSCLC) [abstract]. Presented at ESMO 2017 Congress September 8–12, 2017; Madrid, Spain.
23.
BorghaeiH1Paz-AresLHornL, et al.Nivolumab versus docetaxel in advanced nonsquamous non-small-cell lung cancer. N Engl J Med2015; 373: 1627–1639.
