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Lessomo FYN, Mandizadza OO, Mukuka C, Wang ZQ. A comprehensive review on immune checkpoint inhibitors induced cardiotoxicity characteristics and associated factors. Eur J Med Res 2023; 28:495. [PMID: 37941006 PMCID: PMC10631013 DOI: 10.1186/s40001-023-01464-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/20/2023] [Indexed: 11/10/2023] Open
Abstract
Newly approved cancer drugs called ICIs have shown remarkable success in improving patient survival rates, but they also have the potential for inflammatory and immune-related side effects, including those affecting the cardiovascular system. Research has been conducted to understand the development of these toxicities and identify risk factors. This review focuses on the characteristics of ICI-induced cardiotoxicity and discusses the reported risk factors. It is important for cardio-oncologists to understand the basic concepts of these drugs to better understand how cardiotoxicities occur. It might be hard to find reports, where all patients treated with ICIs had developed cardiac toxicity, because there could be other existing and variable factors that influence the likelihood or risk of developing cardiotoxicity during treatment. Various clinical parameters have been explored as potential risk factors, and further investigation is needed through large-scale studies.
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Affiliation(s)
| | | | | | - Zhi-Quan Wang
- Cardiology Department, Zhongnan Hospital of Wuhan University, Wuhan, China.
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Basak EA, de Joode K, Uyl TJ, van der Wal R, Schreurs MW, van den Berg SA, Oomen-de Hoop E, van der Leest CH, Chaker L, Feelders RA, van der Veldt AA, Joosse A, Koolen SL, Aerts JG, Mathijssen RH, Bins S. The course of C-peptide levels in patients developing diabetes during anti-PD-1 therapy. Biomed Pharmacother 2022; 156:113839. [DOI: 10.1016/j.biopha.2022.113839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/01/2022] [Accepted: 10/06/2022] [Indexed: 11/02/2022] Open
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Popovic DS, Koufakis T, Kovacevic B, Rizzo M, Papanas N. Immune checkpoint inhibitors-induced diabetes mellitus: a growing clinical presentation requiring our attention. Expert Opin Drug Saf 2022; 21:1337-1339. [PMID: 36219612 DOI: 10.1080/14740338.2022.2134343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Djordje S Popovic
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Vojvodina, Novi Sad, Serbia
- Medical Faculty, University of Novi Sad, Novi Sad, Serbia
| | - Theocharis Koufakis
- Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Bojan Kovacevic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Manfredi Rizzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (Promise), University of Palermo, Palermo, Italy
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupoli, Greece
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Zheng ZK, Wang JL, Li WX, Wu TQ, Chen MS, Zhou ZG. Anti-programmed Cell Death Protein-1 Therapy in Intrahepatic Cholangiocarcinoma Induced Type 1 Diabetes: A Case Report and Literature Review. Front Public Health 2022; 10:917679. [PMID: 35784237 PMCID: PMC9243496 DOI: 10.3389/fpubh.2022.917679] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/25/2022] [Indexed: 12/16/2022] Open
Abstract
Immune checkpoint inhibitors, widely used in the treatment of malignancies, can improve the prognosis of patients, while it also can induce various immune-related adverse events, and type 1 diabetes induced by anti-programmed cell death protein-1 is a rare but severe complication. Here we reported a case of type 1 diabetes induced by anti-PD-1 which was to treat intrahepatic cholangiocarcinoma. The case was a 61-year-old female who developed diabetes and ketoacidosis symptoms at the 16th week after anti-PD-1 therapy. Her blood glucose was 30.32 mmol/L, HBA1c was 8.10%, and C-peptide was <0.10 ng/ml. The patient was diagnosed as fulminant type 1 diabetes mellitus complicated with ketoacidosis induced by anti-PD-1, and was treated with massive fluid rehydration, intravenous infusion of insulin and correction of acid-base electrolyte disorder. Hepatectomy was performed after stabilization, and the patient was treated with long-term insulin. Through the case report and literature review, this study aims to improve oncologists' understanding of anti-PD-1 induced type 1 diabetes, so as to make early diagnosis and treatment of the complications and ensure medical safety.
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Affiliation(s)
- Zhi-Kai Zheng
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Jiong-Liang Wang
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Wen-Xuan Li
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Tian-Qing Wu
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Min-Shan Chen
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Zhong-Guo Zhou
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, China
- *Correspondence: Zhong-Guo Zhou
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5
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Abstract
Drug-induced diabetes mellitus is a growing problem in clinical practice. New, potent medications contribute to this problem in a population already at high risk of developing glucose disturbances because of poor lifestyle habits and high prevalence of being overweight/obese. The present review focuses on four important pharmacological classes: glucocorticoids; antipsychotics, especially second generation; antiretroviral therapies, which revolutionised the management of individuals with HIV; and immune checkpoint inhibitors, recently used for the immunotherapy of cancer. For each class, the prevalence of drug-induced diabetes will be evaluated, the most common clinical presentations will be described, the underlying mechanisms leading to hyperglycaemia will be briefly analysed, and some recommendations for appropriate monitoring and management will be proposed.
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Affiliation(s)
- Bruno Fève
- Department of Endocrinology, CRMR PRISIS, Saint-Antoine Hospital, AP-HP, Paris, France.
- Centre de Recherche Saint-Antoine, Institute of Cardiometabolism and Nutrition, Sorbonne University-Inserm, Paris, France.
| | - André J Scheen
- Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU Liège, Liège, Belgium.
- Division of Clinical Pharmacology, Center for Interdisciplinary Research on Medicines (CIRM), University of Liège, Liège, Belgium.
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Charles S, Poullard A. Occurrence of Type 1 Diabetes in A Patient Enrolled in An Immunotherapy Combination Phase 1 Clinical Trial: A Case Study. Asia Pac J Oncol Nurs 2021; 8:737-739. [PMID: 34790859 PMCID: PMC8522589 DOI: 10.4103/apjon.apjon-2122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/21/2021] [Indexed: 11/24/2022] Open
Abstract
Advances in cancer immunotherapy treatments have shown promising results in patients with metastatic malignancy who have been refractory to prior treatments. Immune checkpoint inhibitors such as pembrolizumab in combination with other systemic agents may unleash immune-related adverse events (irAEs). Immunotherapy-induced Type 1 diabetes is rare; however, if left undiagnosed, it may cause life-threatening metabolic endocrinopathies. Advanced practice registered nurses are in a unique position to recognize and identify this irAE and in doing so can provide pathways for early diagnosis and treatments, thus leading to improved clinical and patient outcomes.
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Affiliation(s)
- Sheena Charles
- Department of Investigational Cancer Therapeutics (A Phase 1 Program), University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anna Poullard
- Department of Investigational Cancer Therapeutics (A Phase 1 Program), University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Abstract
In this essay, we show that 3 distinct approaches to immunological exhaustion coexist and that they only partially overlap, generating potential misunderstandings. Exploring cases ranging from viral infections to cancer, we propose that it is crucial, for experimental and therapeutic purposes, to clarify these approaches and their interconnections so as to make the concept of exhaustion genuinely operational.
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Affiliation(s)
- Hannah Kaminski
- ImmunoConcept, CNRS & University of Bordeaux, Bordeaux, France
| | - Maël Lemoine
- ImmunoConcept, CNRS & University of Bordeaux, Bordeaux, France
| | - Thomas Pradeu
- ImmunoConcept, CNRS & University of Bordeaux, Bordeaux, France
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Komiyama S, Numata K, Ogushi K, Chuma M, Tanaka R, Chiba S, Otani M, Inayama Y, Nakano M, Maeda S. Liver Injury and Use of Contrast-Enhanced Ultrasound for Evaluating Intrahepatic Recurrence in a Case of TACE-Refractory Hepatocellular Carcinoma Receiving Atezolizumab-Bevacizumab Combination Therapy: A Case Report. Diagnostics (Basel) 2021; 11:diagnostics11081394. [PMID: 34441328 PMCID: PMC8392634 DOI: 10.3390/diagnostics11081394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 12/29/2022] Open
Abstract
A 67-year-old male with type 2 diabetes (T2DM) was diagnosed with postoperative intrahepatic recurrence for hepatocellular carcinoma (HCC). Nine sessions of transarterial chemoembolization (TACE) proved ineffective, and the patient was diagnosed as having TACE-refractory disease and received seven cycles of atezolizumab-bevacizumab combination therapy. After that, the patient developed hyperglycemia with the HbA1c elevation and the marked fasting serum C-peptide reduction and was diagnosed with developed immune-mediated diabetes (IMD) (T2DM exacerbation with insulin-dependent diabetes development). Subsequently, the hepatobiliary enzyme levels, which were high before the systemic therapy, worsened. Thus, we clinically diagnosed an exacerbation of liver injury due to TACE-induced liver injury complicated by drug-induced liver injury such as immune-mediated hepatotoxicity (IMH). Meanwhile, after contrast-enhanced computed tomography revealed complete response, contrast-enhanced ultrasound was performed to assess intrahepatic recurrence. We found that the latter modality allowed earlier and more definitive diagnosis of intrahepatic recurrence of HCC. Subsequently, despite systemic therapy discontinuation and steroids administration, the liver injury worsened, and the patient died. The autopsy revealed intrahepatic recurrence of HCC and extensive arterial obstruction by the beads used for TACE within the liver, which indicated that disturbed circulation was the primary cause of the liver injury and histopathologically confirmed IMD, but not IMH.
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Affiliation(s)
- Satoshi Komiyama
- Chemotherapy Department, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Kanagawa, Japan;
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Kanagawa, Japan; (K.O.); (M.C.)
| | - Kazushi Numata
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Kanagawa, Japan; (K.O.); (M.C.)
- Correspondence: ; Tel.: +81-45-261-5656
| | - Katsuaki Ogushi
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Kanagawa, Japan; (K.O.); (M.C.)
| | - Makoto Chuma
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Kanagawa, Japan; (K.O.); (M.C.)
| | - Reiko Tanaka
- Division of Diagnostic Pathology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Kanagawa, Japan; (R.T.); (M.O.); (Y.I.)
| | - Sawako Chiba
- Department of Clinical Laboratory, Yokohama Medical Center, National Hospital Organization, 3-60-2 Harajuku, Totsuka-ku, Yokohama 245-8575, Kanagawa, Japan;
| | - Masako Otani
- Division of Diagnostic Pathology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Kanagawa, Japan; (R.T.); (M.O.); (Y.I.)
| | - Yoshiaki Inayama
- Division of Diagnostic Pathology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Kanagawa, Japan; (R.T.); (M.O.); (Y.I.)
| | - Masayuki Nakano
- Tokyo Central Pathology Laboratory, 838-1, Utsukimachi, Hachioji-shi, Tokyo 192-0024, Japan;
| | - Shin Maeda
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Kanagawa, Japan;
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