Acquired lipodystrophy associated with immune checkpoint inhibitors

Area of Science:

• Immunology
• Oncology
• Endocrinology

Background:

• Immune checkpoint inhibitors, particularly anti-programmed cell death-1 (anti-PD-1) therapies, are standard treatments for metastatic melanoma.
• Understanding the full spectrum of adverse events associated with these therapies is crucial for patient management.

Observation:

• A case of acquired generalized lipodystrophy (AGL) developed during anti-PD-1 therapy.
• A systematic literature review identified a total of four cases of lipodystrophy associated with anti-PD-1 immunotherapy (nivolumab and pembrolizumab).

Findings:

• Body composition changes, specifically AGL with significant subcutaneous fat loss, occurred a median of 7 months post-therapy initiation.
• Three of the reported cases, including the current one, were associated with insulin resistance.

Implications:

• Acquired generalized lipodystrophy should be recognized as a potential adverse event of anti-PD-1 therapy.
• Early identification and management of AGL and associated metabolic complications like insulin resistance are important in patients receiving immunotherapy.