Diabetic ketoacidosis induced by nivolumab in invasive mucinous adenocarcinoma of the lung

Nivolumab is the first programmed cell death receptor 1 (PD-1) inhibitor approved in China. Compared with chemotherapy, nivolumab has shown advantages of good efficacy and safety in the treatment of a variety of tumors. However, due to its short time of use in China and lack of safety experience, cl...

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Autores: Yan, Juan, Xie, Zheng-Zheng, Morán, Teresa, Gridelli, Cesare, Zheng, Mao-Dong, Dai, Su-Juan
Tipo de recurso: artículo
Fecha de publicación:2022
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:281741
Acceso en línea:https://ddd.uab.cat/record/281741
https://dx.doi.org/urn:doi:10.21037/atm-22-5211
Access Level:acceso abierto
Palabra clave:Case report
Diabetic ketoacidosis
Immunotherapy adverse effects
Nivolumab
Programmed cell death receptor 1 inhibitor (PD-1 inhibitor)
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spelling Diabetic ketoacidosis induced by nivolumab in invasive mucinous adenocarcinoma of the lunga case report and review of the literatureYan, JuanXie, Zheng-ZhengMorán, TeresaGridelli, CesareZheng, Mao-DongDai, Su-JuanCase reportDiabetic ketoacidosisImmunotherapy adverse effectsNivolumabProgrammed cell death receptor 1 inhibitor (PD-1 inhibitor)Nivolumab is the first programmed cell death receptor 1 (PD-1) inhibitor approved in China. Compared with chemotherapy, nivolumab has shown advantages of good efficacy and safety in the treatment of a variety of tumors. However, due to its short time of use in China and lack of safety experience, clinical understanding of its adverse reactions has not been sufficiently elucidated. In recent years, cases of diabetic ketoacidosis caused by nivolumab have been reported in the emergency department, which has aroused our concern. Here we present a serious case of diabetic ketoacidosis in a 69-year-old woman with invasive mucinous adenocarcinoma of the lung, which occurred following therapy with the PD-1 inhibitor nivolumab and dendritic cell/cytokine-induced killer cell (DC/CIK) immunotherapy. She presented with diabetic ketoacidosis 5 days after the second cycle of nivolumab administration. The patient presented with dry mouth symptoms, a maximum blood glucose of 511.2 mg/dL, hemoglobin A1c (HbA1c) level of 7.4%, urine ketone body value of 3+, and extracellular fluid residual alkali level of -3.8 mmol/L. Normal saline and insulin was initiated. The patient had no history of obesity or family history of diabetes. She received a single dose of 3.75 mg of dexamethasone treatment during this period of time which resulted in cough improvement, but did not explain the onset of the diabetes. She was treated with insulin, sitagliptin phosphate tablets and acarbose tablets. Diabetic ketoacidosis was considered an immune-related toxicity caused by nivolumab, and consequently, treatment with nivolumab was suspended. Patient was maintained under insulin treatment with a blood glucose levels normalization. The incubation period of nivolumab-induced diabetic ketoacidosis is dispersive and the clinical risk is high. Patients need life-long insulin therapy. Blood glucose and HbA1c should be monitored routinely before and during nivolumab immunotherapy to avoid the occurrence of diabetic ketoacidosis. After the occurrence of diabetic ketoacidosis, insulin should be used to actively control blood glucose and do a good job in medication education to ensure long-term compliance of patients. Nivolumab should only be initiated if the patient has a clinical benefit under stable glucose control.Universitat Autònoma de Barcelona 22022-01-0120222022-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/281741https://dx.doi.org/urn:doi:10.21037/atm-22-5211reponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.https://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:ddd.uab.cat:2817412026-06-06T12:50:31Z
dc.title.none.fl_str_mv Diabetic ketoacidosis induced by nivolumab in invasive mucinous adenocarcinoma of the lung
a case report and review of the literature
title Diabetic ketoacidosis induced by nivolumab in invasive mucinous adenocarcinoma of the lung
spellingShingle Diabetic ketoacidosis induced by nivolumab in invasive mucinous adenocarcinoma of the lung
Yan, Juan
Case report
Diabetic ketoacidosis
Immunotherapy adverse effects
Nivolumab
Programmed cell death receptor 1 inhibitor (PD-1 inhibitor)
title_short Diabetic ketoacidosis induced by nivolumab in invasive mucinous adenocarcinoma of the lung
title_full Diabetic ketoacidosis induced by nivolumab in invasive mucinous adenocarcinoma of the lung
title_fullStr Diabetic ketoacidosis induced by nivolumab in invasive mucinous adenocarcinoma of the lung
title_full_unstemmed Diabetic ketoacidosis induced by nivolumab in invasive mucinous adenocarcinoma of the lung
title_sort Diabetic ketoacidosis induced by nivolumab in invasive mucinous adenocarcinoma of the lung
dc.creator.none.fl_str_mv Yan, Juan
Xie, Zheng-Zheng
Morán, Teresa
Gridelli, Cesare
Zheng, Mao-Dong
Dai, Su-Juan
author Yan, Juan
author_facet Yan, Juan
Xie, Zheng-Zheng
Morán, Teresa
Gridelli, Cesare
Zheng, Mao-Dong
Dai, Su-Juan
author_role author
author2 Xie, Zheng-Zheng
Morán, Teresa
Gridelli, Cesare
Zheng, Mao-Dong
Dai, Su-Juan
author2_role author
author
author
author
author
dc.contributor.none.fl_str_mv Universitat Autònoma de Barcelona
dc.subject.none.fl_str_mv Case report
Diabetic ketoacidosis
Immunotherapy adverse effects
Nivolumab
Programmed cell death receptor 1 inhibitor (PD-1 inhibitor)
topic Case report
Diabetic ketoacidosis
Immunotherapy adverse effects
Nivolumab
Programmed cell death receptor 1 inhibitor (PD-1 inhibitor)
description Nivolumab is the first programmed cell death receptor 1 (PD-1) inhibitor approved in China. Compared with chemotherapy, nivolumab has shown advantages of good efficacy and safety in the treatment of a variety of tumors. However, due to its short time of use in China and lack of safety experience, clinical understanding of its adverse reactions has not been sufficiently elucidated. In recent years, cases of diabetic ketoacidosis caused by nivolumab have been reported in the emergency department, which has aroused our concern. Here we present a serious case of diabetic ketoacidosis in a 69-year-old woman with invasive mucinous adenocarcinoma of the lung, which occurred following therapy with the PD-1 inhibitor nivolumab and dendritic cell/cytokine-induced killer cell (DC/CIK) immunotherapy. She presented with diabetic ketoacidosis 5 days after the second cycle of nivolumab administration. The patient presented with dry mouth symptoms, a maximum blood glucose of 511.2 mg/dL, hemoglobin A1c (HbA1c) level of 7.4%, urine ketone body value of 3+, and extracellular fluid residual alkali level of -3.8 mmol/L. Normal saline and insulin was initiated. The patient had no history of obesity or family history of diabetes. She received a single dose of 3.75 mg of dexamethasone treatment during this period of time which resulted in cough improvement, but did not explain the onset of the diabetes. She was treated with insulin, sitagliptin phosphate tablets and acarbose tablets. Diabetic ketoacidosis was considered an immune-related toxicity caused by nivolumab, and consequently, treatment with nivolumab was suspended. Patient was maintained under insulin treatment with a blood glucose levels normalization. The incubation period of nivolumab-induced diabetic ketoacidosis is dispersive and the clinical risk is high. Patients need life-long insulin therapy. Blood glucose and HbA1c should be monitored routinely before and during nivolumab immunotherapy to avoid the occurrence of diabetic ketoacidosis. After the occurrence of diabetic ketoacidosis, insulin should be used to actively control blood glucose and do a good job in medication education to ensure long-term compliance of patients. Nivolumab should only be initiated if the patient has a clinical benefit under stable glucose control.
publishDate 2022
dc.date.none.fl_str_mv 2
2022-01-01
2022
2022-01-01
dc.type.none.fl_str_mv Article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://ddd.uab.cat/record/281741
https://dx.doi.org/urn:doi:10.21037/atm-22-5211
url https://ddd.uab.cat/record/281741
https://dx.doi.org/urn:doi:10.21037/atm-22-5211
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by-nc-nd/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by-nc-nd/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:Dipòsit Digital de Documents de la UAB
instname:Universitat Autònoma de Barcelona
instname_str Universitat Autònoma de Barcelona
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