Anti-PD-1 treatment-induced immediate central diabetes insipidus: a case report

Area of Science:

• Oncology
• Immunology
• Endocrinology

Background:

• Programmed cell death protein 1 (PD-1) pathway modulation is a key strategy in cancer therapy, particularly for lymphomas.
• PD-1/PD-L1 axis is frequently implicated in tumor immune evasion, making it a target for immunotherapies like anti-PD-1 antibodies.
• Classical Hodgkin's lymphoma often exhibits PD-L1 expression on tumor cells, suggesting sensitivity to PD-1 blockade.

Observation:

• A 60-year-old male with relapsed classical Hodgkin's lymphoma received sintilimab, an anti-PD-1 monoclonal antibody.
• The patient experienced rapid onset of symptoms including chills, hyperthermia, and polyuria shortly after treatment initiation.
• Diagnostic evaluation revealed central diabetes insipidus (cDI) as the cause of these symptoms.

Findings:

• This is the first reported case of immediate-onset central diabetes insipidus (cDI) directly attributed to anti-PD-1 therapy.
• The patient's cDI resolved after a 3-month course of glucocorticoids and desmopressin acetate.
• Resolution of symptoms and diagnostic markers indicated successful management of the immunotherapy-induced endocrine complication.

Implications:

• Central diabetes insipidus is a rare but significant adverse event associated with PD-1 inhibitor immunotherapy.
• Clinicians should maintain a high index of suspicion for endocrine complications, including cDI, in patients treated with anti-PD-1 agents.
• Early recognition and management of cDI are crucial for patient recovery and continuation of potentially life-saving cancer treatments.