Table 1.
Characteristics of type 1 diabetic patients under anti-PD-1 ± anti CTLA-4 therapy in our center
| Characteristics | Patient 1 | Patient 2 | Patient 3 |
|---|---|---|---|
| Age (years) | 73 | 84 | 34 |
| Gender | Male | Female | Male |
| Time (weeks) between anti PD-1 treatment initiation and hyperglycemia | 6 | 6 | 11 |
| Melanoma characteristics | Breslow 2.65 mm, BRAF-mutated melanoma. He received adjuvant interferon treatment for 10 months, which was stopped because of Graves’ disease occurrence. He received first-line treatment with vemurafenib and cobimetinib combination because of lung, lymph node and hepatic metastatic progression (3 months). Second-line treatment consisted of anti PD-1 treatment (nivolumab) because of progression | A nasal cavity, BRAF wild-type but NRAS mutated melanoma, with secondary lung metastasis evolution after surgical treatment and adjuvant radiotherapy. Her first-line treatment was anti PD-1 (pembrolizumab) | He received third-line treatment with combination therapy ipilimumab and nivolumab after ipilimumab (with hypophysitis occurrence) then nivolumab alone |
| Symptoms at diabetes diagnosis | Abdominal pain and vomiting associated with a polyuria-polydipsia syndrome | Asthenia and somnolence, polyuria-polydypsia syndrome, and loss of 5 kg |
No symptoms No family history of T2D No personal history of hypertension, overweight or dyslipidemia |
| Glycemia (mmol/l) | 27.78 | 26.71 | 21.44 |
| Dipstick test | 3 crosses glucose and ketone | 3 crosses glucose and ketone | No ketonuria |
| Creatinine (µmol/l) | 177 (baseline: 90) | 156 (baseline: 60) | N/A |
| HCO3-/pH | 18 mmol/l/N/A | 6 mmol/l/7.128 | N/A |
| HbA1c% (mmol/mol) | 7.2 (55.2) | 8.6 (70.5) | 5.4 (35.5) |
| Auto antibodies: GADA/IA-2A/ZnT8A (UI/l) | > 2000/27/802.3 | > 2000/298/<10 | Negatives |
| C peptide/insulin | Undetectable | ||
| Management of immune-related adverse event | Anti PD-1 maintained 3.5 weeks, then resumed with insulin therapy | Pembrolizumab was stopped after the acute event and glycemia normalization with insulin therapy treatment despite tumor response. Follow-up and resumption will be discussed depending on evolution | Anti PD-1 continuation with insulin therapy |