Cemiplimab and diabetic ketoacidosis: a case report of a rare endocrinopathy associated with immune checkpoint inhibitors
BackgroundImmune checkpoint inhibitors (ICIs) have revolutionised the cancer treatment landscape in the last decades, improving the outcome of several tumours, such as cutaneous squamous cell carcinoma (cSCC). ICIs are antibodies blocking several immune checkpoint pathways, as cytotoxic T lymphocyte...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2025-03-01
|
| Series: | Frontiers in Endocrinology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2025.1550702/full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849392877570883584 |
|---|---|
| author | Anna Arecco Cristian Petolicchio Alessandro Pastorino Enrica Teresa Tanda Enrica Teresa Tanda Lara Vera Mara Boschetti Mara Boschetti Francesco Cocchiara Davide Carlo Maggi Davide Carlo Maggi Diego Ferone Diego Ferone Federico Gatto Federico Gatto |
| author_facet | Anna Arecco Cristian Petolicchio Alessandro Pastorino Enrica Teresa Tanda Enrica Teresa Tanda Lara Vera Mara Boschetti Mara Boschetti Francesco Cocchiara Davide Carlo Maggi Davide Carlo Maggi Diego Ferone Diego Ferone Federico Gatto Federico Gatto |
| author_sort | Anna Arecco |
| collection | DOAJ |
| description | BackgroundImmune checkpoint inhibitors (ICIs) have revolutionised the cancer treatment landscape in the last decades, improving the outcome of several tumours, such as cutaneous squamous cell carcinoma (cSCC). ICIs are antibodies blocking several immune checkpoint pathways, as cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) and programmed cell death 1 (PD-1) with its ligand PD-L1. However, the activation of immune response can cause a broad range of side effects, called immune-related adverse events (irAEs). Endocrine irAEs are mainly represented by thyroid dysfunctions (thyrotoxicosis or hypothyroidism) and hypophysitis, while adrenal insufficiency and diabetes mellitus (DM) are less common. Diabetic ketoacidosis (DKA) is a potential life-threatening presentation of ICI-induced insulin-dependent DM (IDDM). This report presents a rare case of DKA and IDDM secondary to anti-PD-1 antibody cemiplimab therapy, and this is the third described in the literature to date.Case presentationWe describe the case of a 62-year-old female patient with metastatic perianal squamous cell carcinoma who developed DKA and IDDM after the fifth cycle of cemiplimab. Hyperglycemia (1187 mg/dL), metabolic acidosis (pH 7.27) with bicarbonate levels of 11.9 mmol/L, arterial partial pressure of carbon dioxide of 25.7 mmHg with increased anion gap (equal to 25), and hyperketonuria were present. Adequate glycaemic control was difficult to maintain, and intravenously therapy (insulin, sodium bicarbonate, potassium, and fluids) was required for a long time. Subcutaneous basal-bolus insulin treatment was started, but glycaemic control was scarce, also due to the concomitant administration of prednisone for immune-related hepatotoxicity, until the subject’s death.ConclusionThis report underlines the importance of the awareness on endocrine irAEs with ICIs, particularly life-threatening DKA. A baseline assessment of glycemia and glycated hemoglobin is mandatory, and we recommend a close monitoring of glycemic trend over time during ICIs therapy. Patients and their caregivers should be informed and counselled to recognise DKA signs and symptoms. |
| format | Article |
| id | doaj-art-3dabfdad03794d298e37ac2ceca510c1 |
| institution | Kabale University |
| issn | 1664-2392 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj-art-3dabfdad03794d298e37ac2ceca510c12025-08-20T03:40:40ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922025-03-011610.3389/fendo.2025.15507021550702Cemiplimab and diabetic ketoacidosis: a case report of a rare endocrinopathy associated with immune checkpoint inhibitorsAnna Arecco0Cristian Petolicchio1Alessandro Pastorino2Enrica Teresa Tanda3Enrica Teresa Tanda4Lara Vera5Mara Boschetti6Mara Boschetti7Francesco Cocchiara8Davide Carlo Maggi9Davide Carlo Maggi10Diego Ferone11Diego Ferone12Federico Gatto13Federico Gatto14Endocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, Genova, ItalyEndocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, Genova, ItalyMedical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genova, ItalyDepartment of Internal Medicine and Medical Specialties, University of Genova, Genova, ItalyMedical Oncology 2, IRCCS Policlinico San Martino, Genova, ItalyEndocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genova, ItalyEndocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, Genova, ItalyEndocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genova, ItalyEndocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genova, ItalyEndocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, Genova, ItalyEndocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genova, ItalyEndocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, Genova, ItalyEndocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genova, ItalyEndocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, Genova, ItalyEndocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genova, ItalyBackgroundImmune checkpoint inhibitors (ICIs) have revolutionised the cancer treatment landscape in the last decades, improving the outcome of several tumours, such as cutaneous squamous cell carcinoma (cSCC). ICIs are antibodies blocking several immune checkpoint pathways, as cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) and programmed cell death 1 (PD-1) with its ligand PD-L1. However, the activation of immune response can cause a broad range of side effects, called immune-related adverse events (irAEs). Endocrine irAEs are mainly represented by thyroid dysfunctions (thyrotoxicosis or hypothyroidism) and hypophysitis, while adrenal insufficiency and diabetes mellitus (DM) are less common. Diabetic ketoacidosis (DKA) is a potential life-threatening presentation of ICI-induced insulin-dependent DM (IDDM). This report presents a rare case of DKA and IDDM secondary to anti-PD-1 antibody cemiplimab therapy, and this is the third described in the literature to date.Case presentationWe describe the case of a 62-year-old female patient with metastatic perianal squamous cell carcinoma who developed DKA and IDDM after the fifth cycle of cemiplimab. Hyperglycemia (1187 mg/dL), metabolic acidosis (pH 7.27) with bicarbonate levels of 11.9 mmol/L, arterial partial pressure of carbon dioxide of 25.7 mmHg with increased anion gap (equal to 25), and hyperketonuria were present. Adequate glycaemic control was difficult to maintain, and intravenously therapy (insulin, sodium bicarbonate, potassium, and fluids) was required for a long time. Subcutaneous basal-bolus insulin treatment was started, but glycaemic control was scarce, also due to the concomitant administration of prednisone for immune-related hepatotoxicity, until the subject’s death.ConclusionThis report underlines the importance of the awareness on endocrine irAEs with ICIs, particularly life-threatening DKA. A baseline assessment of glycemia and glycated hemoglobin is mandatory, and we recommend a close monitoring of glycemic trend over time during ICIs therapy. Patients and their caregivers should be informed and counselled to recognise DKA signs and symptoms.https://www.frontiersin.org/articles/10.3389/fendo.2025.1550702/fullimmune checkpoint inhibitorscemiplimabdiabetic ketoacidosisimmune-related adverse eventsdiabetes mellitusanti-PD-1 monoclonal antibody |
| spellingShingle | Anna Arecco Cristian Petolicchio Alessandro Pastorino Enrica Teresa Tanda Enrica Teresa Tanda Lara Vera Mara Boschetti Mara Boschetti Francesco Cocchiara Davide Carlo Maggi Davide Carlo Maggi Diego Ferone Diego Ferone Federico Gatto Federico Gatto Cemiplimab and diabetic ketoacidosis: a case report of a rare endocrinopathy associated with immune checkpoint inhibitors Frontiers in Endocrinology immune checkpoint inhibitors cemiplimab diabetic ketoacidosis immune-related adverse events diabetes mellitus anti-PD-1 monoclonal antibody |
| title | Cemiplimab and diabetic ketoacidosis: a case report of a rare endocrinopathy associated with immune checkpoint inhibitors |
| title_full | Cemiplimab and diabetic ketoacidosis: a case report of a rare endocrinopathy associated with immune checkpoint inhibitors |
| title_fullStr | Cemiplimab and diabetic ketoacidosis: a case report of a rare endocrinopathy associated with immune checkpoint inhibitors |
| title_full_unstemmed | Cemiplimab and diabetic ketoacidosis: a case report of a rare endocrinopathy associated with immune checkpoint inhibitors |
| title_short | Cemiplimab and diabetic ketoacidosis: a case report of a rare endocrinopathy associated with immune checkpoint inhibitors |
| title_sort | cemiplimab and diabetic ketoacidosis a case report of a rare endocrinopathy associated with immune checkpoint inhibitors |
| topic | immune checkpoint inhibitors cemiplimab diabetic ketoacidosis immune-related adverse events diabetes mellitus anti-PD-1 monoclonal antibody |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2025.1550702/full |
| work_keys_str_mv | AT annaarecco cemiplimabanddiabeticketoacidosisacasereportofarareendocrinopathyassociatedwithimmunecheckpointinhibitors AT cristianpetolicchio cemiplimabanddiabeticketoacidosisacasereportofarareendocrinopathyassociatedwithimmunecheckpointinhibitors AT alessandropastorino cemiplimabanddiabeticketoacidosisacasereportofarareendocrinopathyassociatedwithimmunecheckpointinhibitors AT enricateresatanda cemiplimabanddiabeticketoacidosisacasereportofarareendocrinopathyassociatedwithimmunecheckpointinhibitors AT enricateresatanda cemiplimabanddiabeticketoacidosisacasereportofarareendocrinopathyassociatedwithimmunecheckpointinhibitors AT laravera cemiplimabanddiabeticketoacidosisacasereportofarareendocrinopathyassociatedwithimmunecheckpointinhibitors AT maraboschetti cemiplimabanddiabeticketoacidosisacasereportofarareendocrinopathyassociatedwithimmunecheckpointinhibitors AT maraboschetti cemiplimabanddiabeticketoacidosisacasereportofarareendocrinopathyassociatedwithimmunecheckpointinhibitors AT francescococchiara cemiplimabanddiabeticketoacidosisacasereportofarareendocrinopathyassociatedwithimmunecheckpointinhibitors AT davidecarlomaggi cemiplimabanddiabeticketoacidosisacasereportofarareendocrinopathyassociatedwithimmunecheckpointinhibitors AT davidecarlomaggi cemiplimabanddiabeticketoacidosisacasereportofarareendocrinopathyassociatedwithimmunecheckpointinhibitors AT diegoferone cemiplimabanddiabeticketoacidosisacasereportofarareendocrinopathyassociatedwithimmunecheckpointinhibitors AT diegoferone cemiplimabanddiabeticketoacidosisacasereportofarareendocrinopathyassociatedwithimmunecheckpointinhibitors AT federicogatto cemiplimabanddiabeticketoacidosisacasereportofarareendocrinopathyassociatedwithimmunecheckpointinhibitors AT federicogatto cemiplimabanddiabeticketoacidosisacasereportofarareendocrinopathyassociatedwithimmunecheckpointinhibitors |