Case of fulminant type 1 diabetes induced by the anti‐programmed death‐ligand 1 antibody, avelumab

• Published in: Journal of diabetes investigation Vol. 10; no. 5; pp. 1385 - 1387
• Main Authors: Shibayama, Yui, Kameda, Hiraku, Ota, Shoichiro, Tsuchida, Kazuhisa, Cho, Kyu Yong, Nakamura, Akinobu, Miyoshi, Hideaki, Atsumi, Tatsuya
• Format: Journal Article
• Language: English
• Published: Japan John Wiley & Sons, Inc 01.09.2019; John Wiley and Sons Inc; Wiley
• Subjects: Aged; Antibodies, Monoclonal - adverse effects; Antigens; Anti‐programmed death‐ligand 1 antibody; Apoptosis; B7-H1 Antigen - antagonists & inhibitors; B7-H1 Antigen - immunology; Carcinoma, Merkel Cell - drug therapy; Carcinoma, Merkel Cell - immunology; Case Report; Diabetes; Diabetes mellitus; Diabetes mellitus (insulin dependent); Diabetes Mellitus, Type 1 - chemically induced; Diabetes Mellitus, Type 1 - pathology; FDA approval; Female; Fulminant type 1 diabetes; Glucose; Haplotypes; Hemoglobin; Humans; Hyperglycemia; Immune checkpoint inhibitors; Immune‐related adverse events; Immunoglobulins; Immunotherapy; Insulin; Ketosis; Laboratories; Ligands; Lymphocytes; Metastases; Metastasis; Monoclonal antibodies; Patients; Peptides; Prognosis; Proteins; Radiation therapy; Skin Neoplasms - drug therapy; Surgery; Targeted cancer therapy; Tomography; Urine; United States > US; Japan; Fulminant type 1 diabetes; Anti-programmed death-ligand 1 antibody; Immune-related adverse events
• ISSN: 2040-1116; 2040-1124
• DOI: 10.1111/jdi.13022

With the expansive use of immune checkpoint inhibitors, the frequency of immune‐related adverse events, including autoimmune type 1 diabetes, has been exponentially increased. The anti‐programmed death‐ligand 1 antibody, avelumab, has recently been approved for metastatic Merkel cell carcinoma therapy. Here, we report a patient that developed fulminant type 1 diabetes during avelumab treatment. An 81‐year‐old woman with no history of diabetes received avelumab for metastatic Merkel cell carcinoma. Elevated plasma glucose level (483 mg/dL), hemoglobin A1c level (7.5%) and ketosis were observed after 10 courses of avelumab without any symptoms related to hyperglycemia. As the laboratory tests showed insulin depletion, we diagnosed her with fulminant type 1 diabetes induced by avelumab. This is the first reported case of avelumab‐induced type 1 diabetes, illustrating the necessity for close monitoring of glycemic control during avelumab therapy, as well as other immune checkpoint inhibitors. This table shows laboratory findings at admission. The laboratory tests showed insulin depletion, we diagnosed the patient with fulminant type 1 diabetes induced by avelumab.