1
|
Marchand L, Disse E, Dalle S, Reffet S, Vouillarmet J, Fabien N, Thivolet C, Cugnet-Anceau C. The multifaceted nature of diabetes mellitus induced by checkpoint inhibitors. Acta Diabetol 2019; 56:1239-1245. [PMID: 31423559 DOI: 10.1007/s00592-019-01402-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 08/05/2019] [Indexed: 12/30/2022]
Abstract
Immune checkpoint inhibitors (CPI) are increasingly being used in oncology, and many autoimmune side effects have been described. Diabetes mellitus (DM) has been reported in approximately 1% of subjects treated with programmed cell death-1 and programmed death ligand 1 (PD-1/PD-L1) inhibitors, alone or in association with CTLA-4 inhibitors. In the present mini-review, we aimed to describe different clinical pictures and pathophysiology associated with these forms of diabetes. Data on CPI-related DM was gathered from the largest case series in the literature and from our centre dedicated to immunotherapy complications (ImmuCare-Hospices Civils de Lyon). Most cases are acute autoimmune insulin-dependent diabetes which are similar to fulminant diabetes (extremely acute onset with concomitant near-normal HbA1c levels). Other cases, however, have a phenotype close to type 2 diabetes or appear as a decompensation of previously known type 2 diabetes. The occurrence of diabetes can also be a complication of autoimmune pancreatitis induced by CPI use. Finally, two cases of diabetes in a context of autoimmune lipoatrophy have recently been described. Regarding the wide variety of CPI-induced diabetes, the discovery of a glucose disorder under CPI should motivate specialised care for aetiological diagnosis and appropriate treatment.
Collapse
MESH Headings
- Autoimmune Diseases/chemically induced
- Autoimmune Diseases/epidemiology
- Autoimmune Diseases/etiology
- B7-H1 Antigen/antagonists & inhibitors
- B7-H1 Antigen/immunology
- CTLA-4 Antigen/antagonists & inhibitors
- CTLA-4 Antigen/immunology
- Cell Cycle Checkpoints/drug effects
- Cell Cycle Checkpoints/immunology
- Diabetes Mellitus, Lipoatrophic/chemically induced
- Diabetes Mellitus, Lipoatrophic/epidemiology
- Diabetes Mellitus, Lipoatrophic/immunology
- Diabetes Mellitus, Type 1/chemically induced
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 2/chemically induced
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/immunology
- Humans
- Immunotherapy/adverse effects
- Protein Kinase Inhibitors/adverse effects
- Protein Kinase Inhibitors/therapeutic use
Collapse
Affiliation(s)
- Lucien Marchand
- Department of Endocrinology and Diabetes, St. Joseph - St. Luc Hospital, Quai Claude Bernard, 69007, Lyon, France.
| | - Emmanuel Disse
- Department of Endocrinology and Diabetes, Hospices Civils de Lyon, Lyon-Sud Hospital, Pierre-Bénite, France
- CarMeN Laboratory (INSERM U1060, INRA U1235, Université Claude Bernard Lyon1, INSA-Lyon), Lyon 1 University, Oullins, France
| | - Stéphane Dalle
- Department of Dermatology, Hospices Civils de Lyon, Lyon-Sud Hospital, Pierre-Bénite, France
- ImmuCare (Immunology Cancer Research), Hospices Civils de Lyon, Lyon, France
| | - Sophie Reffet
- Department of Endocrinology and Diabetes, Hospices Civils de Lyon, Lyon-Sud Hospital, Pierre-Bénite, France
| | - Julien Vouillarmet
- Department of Endocrinology and Diabetes, Hospices Civils de Lyon, Lyon-Sud Hospital, Pierre-Bénite, France
| | - Nicole Fabien
- Department of Immunology, Hospices Civils de Lyon, Lyon-Sud Hospital, Pierre-Bénite, France
| | - Charles Thivolet
- Department of Endocrinology and Diabetes, Hospices Civils de Lyon, Lyon-Sud Hospital, Pierre-Bénite, France
- CarMeN Laboratory (INSERM U1060, INRA U1235, Université Claude Bernard Lyon1, INSA-Lyon), Lyon 1 University, Oullins, France
| | - Christine Cugnet-Anceau
- Department of Endocrinology and Diabetes, Hospices Civils de Lyon, Lyon-Sud Hospital, Pierre-Bénite, France
- ImmuCare (Immunology Cancer Research), Hospices Civils de Lyon, Lyon, France
| |
Collapse
|
2
|
Marchand L, Thivolet A, Dalle S, Chikh K, Reffet S, Vouillarmet J, Fabien N, Cugnet-Anceau C, Thivolet C. Diabetes mellitus induced by PD-1 and PD-L1 inhibitors: description of pancreatic endocrine and exocrine phenotype. Acta Diabetol 2019; 56:441-448. [PMID: 30284618 DOI: 10.1007/s00592-018-1234-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/21/2018] [Indexed: 01/22/2023]
Abstract
AIMS Programmed cell death-1 and programmed death ligand 1 (PD-1/PD-L1) inhibitors restore antitumor immunity, but many autoimmune side-effects have been described. Diabetes mellitus is a rare complication, and little data concerning its pathophysiology and phenotype have been published. This study aimed to describe both pancreatic endocrine and exocrine functions, immunological features and change in pancreas volume in subjects with diabetes mellitus induced by PD-1 and PD-L1 inhibitors. METHODS We analyzed the data of six subjects treated with immunotherapy who presented acute diabetes. RESULTS There were five men and one woman. Median age was 67 years (range 55-83). Three subjects were treated with nivolumab, two with pembrolizumab and one with durvalumab. Median time to diabetes onset after immunotherapy initiation was 4 months (range 2-13). Four patients presented fulminant diabetes (FD); none of these had type 1 diabetes (T1D)-related autoantibodies, none of them had T1D or FD-very high-risk HLA class II profiles. The bi-hormonal endocrine and exocrine pancreatic failure previously reported for one FD patient was not found in other FD subjects, but glucagon response was blunted in another FD patient. Pancreas volume was decreased at diabetes onset in 2 FD patients, and all patients presented a subsequent decrease of pancreas volume during follow-up. CONCLUSIONS In the patients presented herein, immunotherapy-induced diabetes was not associated with T1D-related autoantibodies. The hormonal and morphological analysis of the pancreatic glands of these six cases contributes to the understanding of the underlying and probably heterogeneous mechanisms. There is a need to find biomarkers to identify patients at risk to develop these new forms of diabetes at early stages of the process to prevent ketoacidosis and to evaluate preventive strategies.
Collapse
Affiliation(s)
- Lucien Marchand
- Department of Endocrinology and Diabetes, Hospices Civils de Lyon, Lyon-Sud Hospital, 165 chemin du Grand Revoyet, Pierre-Bénite, 69310, France.
| | - Arnaud Thivolet
- Department of Radiology, Hospices Civils de Lyon, Lyon, France
| | - Stéphane Dalle
- Department of Dermatology, Hospices Civils de Lyon, Lyon-Sud Hospital, Pierre-Bénite, France
- ImmuCare (Immunology Cancer Research), Hospices Civils de Lyon, Lyon, France
| | - Karim Chikh
- Department of Biochemistry, Hospices Civils de Lyon, Lyon-Sud Hospital, Pierre-Bénite, France
| | - Sophie Reffet
- Department of Endocrinology and Diabetes, Hospices Civils de Lyon, Lyon-Sud Hospital, 165 chemin du Grand Revoyet, Pierre-Bénite, 69310, France
| | - Julien Vouillarmet
- Department of Endocrinology and Diabetes, Hospices Civils de Lyon, Lyon-Sud Hospital, 165 chemin du Grand Revoyet, Pierre-Bénite, 69310, France
| | - Nicole Fabien
- Department of Immunology, Hospices Civils de Lyon, Lyon-Sud Hospital, Pierre-Bénite, France
| | - Christine Cugnet-Anceau
- Department of Endocrinology and Diabetes, Hospices Civils de Lyon, Lyon-Sud Hospital, 165 chemin du Grand Revoyet, Pierre-Bénite, 69310, France
- ImmuCare (Immunology Cancer Research), Hospices Civils de Lyon, Lyon, France
| | - Charles Thivolet
- Department of Endocrinology and Diabetes, Hospices Civils de Lyon, Lyon-Sud Hospital, 165 chemin du Grand Revoyet, Pierre-Bénite, 69310, France
- CarMeN Laboratory (INSERM U1060, INRA U1235, Université Claude Bernard Lyon1, INSA-Lyon), Lyon 1 University, Oullins, France
| |
Collapse
|
3
|
Marchand L, Reffet S, Dalle S, Disse E, Vouillarmet J, Cugnet-Anceau C, Thivolet C. Fulminant diabetes induced by PD-1 and PD-L1 inhibitors: what about glucose variability? Acta Diabetol 2019; 56:377-378. [PMID: 30506459 DOI: 10.1007/s00592-018-1262-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/17/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Lucien Marchand
- Department of Endocrinology and Diabetes, Hospices Civils de Lyon, Lyon-Sud Hospital, 165 chemin du Grand Revoyet, 69310, Pierre-Bénite, France.
| | - Sophie Reffet
- Department of Endocrinology and Diabetes, Hospices Civils de Lyon, Lyon-Sud Hospital, 165 chemin du Grand Revoyet, 69310, Pierre-Bénite, France
| | - Stéphane Dalle
- Department of Dermatology, Hospices Civils de Lyon, Lyon-Sud Hospital, Pierre-Bénite, France
- ImmuCare (Immunology Cancer Research), Hospices Civils de Lyon, Lyon, France
| | - Emmanuel Disse
- Department of Endocrinology and Diabetes, Hospices Civils de Lyon, Lyon-Sud Hospital, 165 chemin du Grand Revoyet, 69310, Pierre-Bénite, France
- Lyon 1 University, CarMeN Laboratory (INSERM U1060, INRA U1235, Université Claude Bernard Lyon1, INSA-Lyon), Oullins, France
| | - Julien Vouillarmet
- Department of Endocrinology and Diabetes, Hospices Civils de Lyon, Lyon-Sud Hospital, 165 chemin du Grand Revoyet, 69310, Pierre-Bénite, France
| | - Christine Cugnet-Anceau
- Department of Endocrinology and Diabetes, Hospices Civils de Lyon, Lyon-Sud Hospital, 165 chemin du Grand Revoyet, 69310, Pierre-Bénite, France
- ImmuCare (Immunology Cancer Research), Hospices Civils de Lyon, Lyon, France
| | - Charles Thivolet
- Department of Endocrinology and Diabetes, Hospices Civils de Lyon, Lyon-Sud Hospital, 165 chemin du Grand Revoyet, 69310, Pierre-Bénite, France
- Lyon 1 University, CarMeN Laboratory (INSERM U1060, INRA U1235, Université Claude Bernard Lyon1, INSA-Lyon), Oullins, France
| |
Collapse
|
4
|
Amouyal C, Levy P, Andreelli F, Hartemann A. Acute pancreatitis with dipeptidyl peptidase-4 (DPP4) inhibitor or fulminant type 1 diabetes? Diabetes Metab 2018; 44:95-96. [PMID: 28483292 DOI: 10.1016/j.diabet.2017.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 06/07/2023]
Affiliation(s)
- C Amouyal
- Department of Diabetology, Assistance publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, 75013 Paris, France; Institute of Cardiometabolism and Nutrition, 75013 Paris, France; UMR S1166, Pierre-and-Marie-Curie University-Paris VI, 75013 Paris, France.
| | - P Levy
- Department of Gastroenterology/Pancreatology, Assistance publique-Hôpitaux de Paris (AP-HP), Beaujon Hospital, 92110 Clichy, France; DHU UNITY, Denis Diderot University-Paris VII, 92110 Paris, France
| | - F Andreelli
- Department of Diabetology, Assistance publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, 75013 Paris, France; Institute of Cardiometabolism and Nutrition, 75013 Paris, France; UMR S1166, Pierre-and-Marie-Curie University-Paris VI, 75013 Paris, France
| | - A Hartemann
- Department of Diabetology, Assistance publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, 75013 Paris, France; Institute of Cardiometabolism and Nutrition, 75013 Paris, France; UMR S938, Pierre-and-Marie-Curie University-Paris VI, 75006 Paris, France
| |
Collapse
|
5
|
Abstract
Diabetes affects today an estimated 366 million people world-wide, including 20 million to 40 million of patients with type 1 diabetes (T1D). While T1D accounts for 5% to 20% of those with diabetes, it is associated with higher morbidity, mortality and health care cost than the more prevalent type 2 diabetes. Patients with T1D require exogenous insulin for survival and should be identified as soon as possible after diagnosis to avoid high morbidity due to a delay in insulin treatment. It is also important to present to the patient correct prognosis that differs by the type of diabetes. From the research point of view, correct classification should help to identify the etiologies and to develop specific prevention for T1D. This review summarizes evidence that may be helpful in diagnosing T1D in various ethnic groups. Challenges in interpretation of results commonly used to determine the type of diabetes are highlighted.
Collapse
Affiliation(s)
- Marian Rewers
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO, USA
| |
Collapse
|