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Unexpected outcome (positive or negative) including adverse drug reactions
CASE REPORT
Anti-PD-L1 therapy and the onset of diabetes mellitus with positive pancreatic autoantibodies
  1. Jennifer Way1,
  2. Alexandra Drakaki2,
  3. Andrew Drexler2,
  4. Matthew Freeby1
  1. 1Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
  2. 2Ronald Reagan UCLA Medical Center, Santa Monica, California, USA
  1. Correspondence to Dr Matthew Freeby, mfreeby{at}mednet.ucla.edu

Summary

An 84-year-old woman with metastatic squamous cell carcinoma of the nasopharynx and no history of diabetes was started on the antiprogrammed cell death ligand-1 (anti-PD-L1) antibody durvalumab. Four months later, she presented in diabetic ketoacidosis with glucose 488 mg/dL, anion gap 16, positive serum ketones and A1C9.1%. Antiglutamic acid decarboxylase 65 (GAD) antibody was 13 U/mL (normal, <0.5 U/mL), c-peptide 0.4 ng/dL (normal, 1.1–4.3 ng/mL) and glucose 142 mg/dL. A man with metastatic papillary urothelial carcinoma was treated with the PD-L1 inhibitor atezolizumab. He had no history of diabetes. Nine weeks after initiation, he developed fatigue and polyuria with blood glucose 336 mg/dL, c-peptide 0.6 ng/mL, A1C8.2% and GAD antibodies 28.4 U/mL (normal, <1 U/mL). Due to the diagnosis of autoimmune diabetes, both patients were treated with insulin. Autoimmune diabetes is a rare immune-related adverse effect of PD-L1 inhibitors. We present the first two cases with documented positive pancreatic autoantibodies.

  • diabetes
  • chemotherapy
  • contraindications and precautions

https://doi.org/10.1136/bcr-2017-220415

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    Footnotes

    • Contributors The following authors made the following contributions to this manuscript. 1. JW was instrumental in the acquisition of data of each of the patients reviewed in this case report. She was also involved in review of outside literature as well as reporting of the cases. 2. AD was involved in the care of both patients and provided contributions in reporting as well as analysis and interpretation of the data. 3. AD was involved in the care of the first patient and provided contributions in reporting as well as analysis and interpretation of the data. 4. MF was involved in the care of the second patient, planning, reporting as well as analysis and interpretation of the data. All authors are in agreement with submitting these cases as reported, including background, case presentations and discussion.

    • Competing interests None declared.

    • Patient consent Obtained

    • Provenance and peer review Not commissioned; externally peer reviewed.