Literature case analysis of immune checkpoint inhibitors-associated lipodystrophy

The objective of this study was to investigate the clinical characteristics of lipodystrophy induced by immune checkpoint inhibitors (ICIs). Domestic and international databases were searched as of 28 February 2025 and case reports of ICI-associated lipodystrophy were collected. Relevant information including patients' basic information, ICI application, the occurrence of lipodystrophy, etc., were extracted and descriptively analyzed. A total of 11 patients were included in the analysis, including two males and nine females, age from 34 to 76 years, with an average age of 55 years. The primary diseases were mainly lung cancer, melanoma and renal cell carcinoma. The latency period from ICI initiation to lipodystrophy diagnosis ranged from 42 to 540 days. Clinical manifestations included facial fat pad depletion and subcutaneous fat loss in trunk and extremities. Treatment regimens included pembrolizumab ( n  = 3), nivolumab ( n  = 6), cadonilimab ( n  = 1), and nivolumab/ipilimumab combination ( n  = 1). Serum leptin levels were tested in seven patients, and two had serum leptin concentrations <0.5 ng/ml, the others ranged from 0.6 to 61.1 ng/ml. Eight cases had records of glycated hemoglobin testing, of which five cases had glycated hemoglobin ≥6.5%. After being diagnosed with lipodystrophy, seven patients discontinued ICIs while four continued treatment. Four patients received steroid therapy and seven cases had no relevant records. Among the 11 patients, only one patient demonstrated subcutaneous fat improvement, and seven patients' prognosis was not reported. None of the eight patients who discontinued treatment resumed immunotherapy. ICI-associated lipodystrophy presents similar clinical features to conventional lipodystrophy but shows limited reversibility with treatment cessation or steroid intervention, necessitating increased clinical awareness.