Patients treated with ICIs are at elevated risk of new-onset diabetes compared to standard chemotherapy, according to a recently published study in the journal Metabolism.¹

Patients with malignancy who were treated with either conventional chemotherapy or an immune checkpoint inhibitor (ICI) were enrolled in a study from the Yonsei University College of Medicine in Seoul, South Korea to compare the risk of new-onset diabetes between patients receiving an ICI and those receiving conventional chemotherapy. None of the 1326 subjects included in the study had diabetes at the time of their enrollment. Of these, 1105 were administered conventional chemotherapy, while the remaining 221 received an ICI. The data for the study was obtained from a tertiary care hospital database.

The retrospective analysis of data showed that the overall incidence of diabetes was higher among patients in the ICI group versus those in the conventional chemotherapy group. Compared to patients treated with conventional chemotherapy, the risk of incident diabetes was increased 2-folds among those treated with ICI with adjusted hazard ratio (aHR) of 2.45. The risk was particularly higher in the male patients and those who developed significant lymphocytosis following administration of ICI. More patients in the ICI group (10.4%) showed an increasing glucose pattern compared to the standard chemotherapy group (7.4%).

Immune checkpoint inhibitors (ICI) are immunotherapeutic agents, which are coming into vogue as a promising treatment approach for patients with cancer. The three FDA-approved checkpoint inhibitors are ipilimumab, pembrolizumab and nivolumab. Like with other chemotherapeutic agents, their use is also associated with immune-related adverse effects, some of which may be severe in nature.²

This study demonstrates the greater probability of new-onset diabetes among patients receiving immunotherapy with ICIs vis-à-vis treatment with standard chemotherapy. It has also identified the at-risk groups. The study further illustrates the need for regularly monitoring blood glucose levels in these patients for timely detection of diabetes associated with the use of ICIs.

References

1. Lee M, et al. Increased risk of incident diabetes after therapy with immune checkpoint inhibitor compared with conventional chemotherapy: A longitudinal trajectory analysis using a tertiary care hospital database. Metabolism. 2022 Sep 16;155311. doi: 10.1016/j.metabol.2022.155311.
2. Bajwa R, et al. Adverse effects of immune checkpoint inhibitors (programmed death-1 inhibitors and cytotoxic T-lymphocyte-associated protein-4 inhibitors): results of a retrospective study. J Clin Med Res. 2019 Apr;11(4):225-236. doi: 10.14740/jocmr3750.