PMID- 31244772
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200225
IS  - 1664-2392 (Print)
IS  - 1664-2392 (Electronic)
IS  - 1664-2392 (Linking)
VI  - 10
DP  - 2019
TI  - Atezolizumab-Induced Autoimmune Diabetes in a Patient With Metastatic Lung 
      Cancer.
PG  - 352
LID - 10.3389/fendo.2019.00352 [doi]
LID - 352
AB  - Context: Immune checkpoint inhibitors (ICIs), now FDA-approved, are increasingly 
      used as an effective treatment of various cancers. Autoimmune diabetes is a rare 
      but life-threatening endocrine adverse event, which has been reported in patients 
      treated with anti-programmed-cell death-1 (anti-PD-1) and anti-programmed-cell 
      death-1 ligand (anti-PD-L1) therapies. Case description: We report a 52-year-old 
      woman with advanced-stage non-small cell lung cancer who presented with diabetic 
      ketoacidosis (DKA) at 24 weeks after atezolizumab initiation. She initially 
      received oral antidiabetic medication from primary care hospital and experienced 
      recurrent DKA 3 days later. Her plasma glucose on the day that she had recurrent 
      DKA was 332 mg/dL (18.4 mmol/L), A1c was 7.9% (63 mmol/mol), fasting C-peptide 
      was <0.03 nmol/L (0.1 ng/ml), fasting insulin level was <1 muIU/ml, anti-glutamic 
      acid decarboxylase 65 (GADA) was 7.2 U/ml (normal, >5 U/ml), and human leukocyte 
      antigen (HLA) class II typing was DR3-DQ2/DR14-DQ5. A diagnosis of autoimmune 
      diabetes was made. After treatment for DKA, she recovered and received 
      basal-bolus insulin treatment. Atezolizumab had been discontinued after the fifth 
      cycle, prior to the development of DKA, due to progression of lung cancer. 
      Conclusion: To date, there has been neither an effective way to detect if a 
      patient is at high risk for autoimmune diabetes nor to prevent the complications 
      associated with it. Regular glucose monitoring is the best method of early 
      diabetes detection. In patients with new onset diabetes following treatment with 
      ICIs, C-peptide levels and GADA should be screened, and insulin therapy should be 
      prescribed to prevent hyperglycemic emergency while waiting for definite 
      diagnosis.
FAU - Sothornwit, Jin
AU  - Sothornwit J
AD  - Division of Endocrinology and Metabolism, Department of Internal Medicine, 
      Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
FAU - Phunmanee, Anakapong
AU  - Phunmanee A
AD  - Division of Critical Care, Department of Internal Medicine, Faculty of Medicine, 
      Khon Kaen University, Khon Kaen, Thailand.
FAU - Pongchaiyakul, Chatlert
AU  - Pongchaiyakul C
AD  - Division of Endocrinology and Metabolism, Department of Internal Medicine, 
      Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
LA  - eng
PT  - Case Reports
DEP - 20190611
PL  - Switzerland
TA  - Front Endocrinol (Lausanne)
JT  - Frontiers in endocrinology
JID - 101555782
PMC - PMC6581023
OTO - NOTNLM
OT  - atezolizumab
OT  - autoimmunity
OT  - checkpoint inhibitor
OT  - diabetes mellitus
OT  - immunotherapy
EDAT- 2019/06/28 06:00
MHDA- 2019/06/28 06:01
PMCR- 2019/01/01
CRDT- 2019/06/28 06:00
PHST- 2019/03/21 00:00 [received]
PHST- 2019/05/17 00:00 [accepted]
PHST- 2019/06/28 06:00 [entrez]
PHST- 2019/06/28 06:00 [pubmed]
PHST- 2019/06/28 06:01 [medline]
PHST- 2019/01/01 00:00 [pmc-release]
AID - 10.3389/fendo.2019.00352 [doi]
PST - epublish
SO  - Front Endocrinol (Lausanne). 2019 Jun 11;10:352. doi: 10.3389/fendo.2019.00352. 
      eCollection 2019.