背景:免疫治疗,特别是使用检查点抑制剂,如帕博利珠单抗,已成为个性化癌症治疗的重要工具。这些抑制剂靶向T细胞上的蛋白质,其调节针对肿瘤细胞的免疫应答。Pembrolizumab,它靶向T细胞上的程序性细胞死亡受体1,已被批准用于治疗转移性黑色素瘤和非小细胞肺癌。然而,它也会导致免疫相关的副作用,包括肺炎,结肠炎,甲状腺异常,和罕见的1型糖尿病病例。
方法:该病例涉及一名30多岁的成年乳腺癌患者,在接受派姆单抗治疗后出现高血糖。该患者被诊断为糖尿病酮症酸中毒,并进行了进一步的研究以评估新发的1型糖尿病。患者有甲状腺功能减退症病史和乳腺癌家族史。开始治疗糖尿病酮症酸中毒,患者出院,接受内分泌学家的密切随访。
结论:这篇文献综述强调了在接受派姆单抗治疗不同类型癌症的患者中糖尿病酮症酸中毒和新发1型糖尿病的发生。总的来说,这篇文章强调了免疫治疗在癌症治疗中的治疗益处,尤其是派博利珠单抗,同时也强调了可能在一小部分患者中发生的免疫相关糖尿病的潜在副作用。在这里,我们提出了一个案例,其中pembrolizumab在几个周期后导致糖尿病的发展,突出了一种罕见但严重的药物毒性。
BACKGROUND: Immunotherapy, specifically the use of checkpoint inhibitors such as pembrolizumab, has become an important tool in personalized cancer therapy. These inhibitors target proteins on T-cells that regulate the immune response against tumor cells. Pembrolizumab, which targets the programmed cell death 1 receptor on T-cells, has been approved for the treatment of metastatic melanoma and non-small cell lung cancer. However, it can also lead to immune-related side effects, including pneumonitis, colitis, thyroid abnormalities, and rare cases of type 1 diabetes.
METHODS: The case presented involves an adult patient in 30s with breast cancer who developed hyperglycemia after receiving pembrolizumab treatment. The patient was diagnosed with diabetic ketoacidosis and further investigations were performed to evaluate for new-onset type 1 diabetes. The patient had a history of hypothyroidism and a family history of breast cancer. Treatment for diabetic ketoacidosis was initiated, and the patient was discharged for close follow-up with an endocrinologist.
CONCLUSIONS: This literature review highlights the occurrence of diabetic ketoacidosis and new-onset type 1 diabetes in patients receiving pembrolizumab treatment for different types of cancer. Overall, the article emphasizes the therapeutic benefits of immunotherapy in cancer treatment, particularly pembrolizumab, while also highlighting the potential side effect of immune-related diabetes that can occur in a small percentage of patients. Here we present a case where pembrolizumab lead to development of diabetes after a few cycles highlighting one of the rare yet a serious toxicity of the drug.