Development Of Type 1 Diabetes After Cancer Immunotherapy

ABSTRACT Objective: Nivolumab, anti–programmed cell death 1 monoclonal antibody, is a newly Food and Drug Administration–approved biologic for the treatment of metastatic melanoma. New indications for treatment of other cancers have been recently granted. Nivolumab package insert reads: “Warnings and Precautions: immune-mediated pneumonitis, colitis, hepatitis, nephritis and renal dysfunction, hypothyroidism and hyperthyroidism may occur.” Development of type 1 diabetes as an adverse event was not documented in the New England Journal of Medicine article that introduced its successful use for melanoma treatment. Methods: We present the case of an adult patient who developed autoimmune diabetes after treatment with nivolumab, accompanied by the presence of high serum titers of glutamic acid decarboxylase 65 (GAD65) isoform antibodies and a clinical presentation of diabetic ketoacidosis. Results: Although endocrine autoimmunity has been described following treatment with nivolumab, type 1 diabetes has only been shown after the treatment of 2 patients with melanoma that happened to be antibody (GAD65, insulin, and islet cell antibody) negative. Conclusion: Clinicians prescribing this drug need to be aware of this life-threatening adverse effect. At a minimum, patient education should be offered to every patient treated with this biologic. Abbreviations: GAD65 glutamic acid decarboxylase 65 PD-1 programmed cell death 1