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Review
. 2024 Jan 22;18(1):51.
doi: 10.1186/s13256-023-04248-7.

Rare, late onset of immune checkpoint inhibitor-induced type 1 diabetes mellitus in a patient with small-cell lung cancer treated with serplulimab: a case report and review of the literature

Peng Ning  1 , Shilan Liu  2 , Hongyi Cao  3
Affiliations
Review

Rare, late onset of immune checkpoint inhibitor-induced type 1 diabetes mellitus in a patient with small-cell lung cancer treated with serplulimab: a case report and review of the literature

Peng Ning et al. J Med Case Rep. .

Abstract

Background: As a newly approved immune checkpoint inhibitor in China, serplulimab has been widely used in the immunotherapy of tumors. However, the immune-related adverse events of immune checkpoint inhibitors should not be ignored. Although immune checkpoint inhibitor-induced type 1 diabetes mellitus is a rare complication, it may cause diabetic ketoacidosis and endanger the lives of patients.

Case presentation: This case report describes a 55-year-old male of Han nationality from China diagnosed with small-cell lung cancer with multiple metastases who experienced an adverse event of type 1 diabetes mellitus 68 weeks after receiving serplulimab therapy. The patient presented with typical symptoms of diabetic ketoacidosis, including severe thirst, nausea, vomiting, deep respirations, and stupor. Despite the absence of diabetes-related autoantibodies, the patient had extremely low levels of insulin and C-peptide release. Other potential causes of diabetes were ruled out, confirming the condition as serplulimab-induced immune checkpoint inhibitor-induced type 1 diabetes mellitus. After aggressive treatment to correct diabetic ketoacidosis, the patient's blood glucose levels stabilized and symptoms of diabetes improved significantly, although long-term insulin maintenance therapy was necessary.

Conclusion: This case highlights a rare, late-onset adverse event of immune checkpoint inhibitor-induced type 1 diabetes mellitus that may be overlooked during treatment with serplulimab. The monitoring of blood glucose levels and early signs and symptoms of diabetes cannot be relaxed at the late stage of treatment, even if patients do not have elevated blood glucose levels before and during the middle stage of treatment.

Keywords: Case report; Immune-checkpoint inhibitor–induced type 1 diabetes mellitus; Late-onset adverse events; Serplulimab; Small-cell lung cancer; Treatment management.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Lung lesion biopsy results of the patient. “Lung”: biopsy of small tissue, combined with histology and immunohistochemistry, to support the diagnosis of small cell carcinoma. Immunohistochemistry: P40* (−), P53* (Diffuse strong +), P16* (Diffuse strong +), CK* (−), K7* (−), CD56* (+), CgA* (+), SYN* (+), CD45* (−), Ki-67*(+ , about 80%)
Fig. 2
Fig. 2
Blood glucose levels of the patient during the treatment process
Fig. 3
Fig. 3
Computed tomography (CT) of the patient’s chest and abdomen during treatment. A Chest computed tomography imaging findings at the beginning of treatment. B Computed tomography of the chest of the patient with ICI-induced type 1 diabetes mellitus. Tumor lesions in B are significantly reduced versus those in A, as indicated by the arrows. C Abdomen computed tomography imaging findings at the beginning of treatment. D Computed tomography of the abdomen of the patient with ICI-induced type 1 diabetes mellitus. The pancreas in D does not show significant atrophy versus that in C, as indicated by the arrows
See this image and copyright information in PMC

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References

    1. Hu H, Wang K, Jia R, Zeng ZX, Zhu M, Deng YL, et al. Current status in rechallenge of immunotherapy. Int J Biol Sci. 2023;19(8):2428–2442. doi: 10.7150/ijbs.82776. - DOI - PMC - PubMed
    1. Yin Q, Wu L, Han L, Zheng X, Tong R, Li L, et al. Immune-related adverse events of immune checkpoint inhibitors: a review. Front Immunol. 2023;14:1167975. doi: 10.3389/fimmu.2023.1167975. - DOI - PMC - PubMed
    1. Verheijden RJ, van Eijs MJM, May AM, van Wijk F, Suijkerbuijk KPM. Immunosuppression for immune-related adverse events during checkpoint inhibition: an intricate balance. NPJ Precis Oncol. 2023;7(1):41. doi: 10.1038/s41698-023-00380-1. - DOI - PMC - PubMed
    1. Profili NI, Castelli R, Gidaro A, Merella A, Manetti R, Palmieri G, et al. Endocrine Sij de effects in patients treated with immune checkpoint inhibitors: a narrative review. J Clin Med. 2023;12(15):5161. doi: 10.3390/jcm12155161. - DOI - PMC - PubMed
    1. Chen X, Affinati AH, Lee Y, Turcu AF, Henry NL, Schiopu E, et al. Immune checkpoint inhibitors and risk of type 1 diabetes. Diabetes Care. 2022;45(5):1170–1176. doi: 10.2337/dc21-2213. - DOI - PMC - PubMed

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