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Immune Checkpoint Inhibitor-Induced Diabetes Across National Cancer Institute Trials That Included PD-1 or PD-L1

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Immune checkpoint inhibitor-induced diabetes (ICI-D) is rare but serious, affecting 0.52% of patients. Its incidence varies with concurrent treatments, and it often requires hospitalization and intensive care.

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Area of Science:

  • Oncology
  • Immunology
  • Endocrinology

Background:

  • Immune-related adverse events (IRAEs) can limit cancer immunotherapy efficacy.
  • Understanding severe IRAEs, such as immune checkpoint inhibitor (ICI)-induced diabetes (ICI-D), is crucial for optimizing immunotherapy use.

Purpose of the Study:

  • To characterize ICI-D by assessing hyperglycemic events in a large patient cohort.
  • To determine the incidence and risk factors associated with ICI-D.

Main Methods:

  • Retrieved adverse event reports related to diabetes, hyperglycemia, and acidosis from the NCI CTEP database (June 2015-December 2022).
  • Analyzed data from 13,966 patients across 158 trials treated with PD-1 or PD-L1 inhibitors.
  • Calculated cumulative incidence rates and used logistic regression to assess the odds of developing ICI-D.

Main Results:

  • The overall cumulative incidence of ICI-D was 0.52% (13,966 patients, 158 trials).
  • ICI-D incidence was lower with concurrent chemotherapy (0.26%) versus without (0.65%) and higher with combination immunotherapy (0.94%) versus monotherapy (0.37%).
  • 90% of ICI-D patients required hospitalization, and 43% needed intensive care.

Conclusions:

  • ICI-D is a rare but morbid complication of cancer immunotherapy.
  • The risk and presentation of ICI-D are influenced by concurrent treatments, particularly chemotherapy and combination immunotherapy.
  • Higher glucose levels may indicate ICI-D, aiding in differentiating its etiology.