Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Nov 24, 2023; 14(11): 535-543
Published online Nov 24, 2023. doi: 10.5306/wjco.v14.i11.535
Autoimmune diabetes from pembrolizumab: A case report and review of literature
Hardikkumar Bhanderi, Farhan Khalid, Zubair Hassan Bodla, Tayyeb Muhammad, Doantrang Du, Trishala Meghal
Hardikkumar Bhanderi, Farhan Khalid, Tayyeb Muhammad, Doantrang Du, Department of Internal Medicine, Monmouth Medical Center, Long branch, NJ 07740, United States
Zubair Hassan Bodla, Department of Internal Medicine, University of Central Florida College of Medicine, Gainesville, FL 32303, United States
Trishala Meghal, Department of Hematology-Oncology, Monmouth Medical Center, Long Branch, NJ 07740, United States
Author contributions: Bhanderi H did conceptualization and did literature review; Khalid F wrote case presentation; Bodla ZH and Muhammad T helped in discussion; Du D and Meghal T helped in final editing.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: Authors does not have any conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hardikkumar Bhanderi, MD, Staff Physician, Department of Internal Medicine, Monmouth Medical Center, 300 2nd Avenue, Long Branch, NJ 07740, United States. dr.hardikkumar.bhanderi@gmail.com
Received: July 13, 2023
Peer-review started: July 13, 2023
First decision: September 26, 2023
Revised: October 13, 2023
Accepted: October 30, 2023
Article in press: October 30, 2023
Published online: November 24, 2023
Processing time: 131 Days and 8.5 Hours
Abstract
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.

CASE SUMMARY

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.

CONCLUSION

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.

Keywords: Pembrolizumab; Breast cancer; Autoimmune diabetes; Keytruda; Immunotherapy; Case report

Core Tip: Our review highlights an important and rare adverse effect of Pembrolizumab. We have also reviewed the number of cycles patients were treated with Keytruda before the onset of diabetes. Clinicians should be watchful for the signs and symptoms. Early discontinuation of immunotherapy is needed to prevent significant morbidity and mortality.