Sintilimab induced diabetic ketoacidosis in a patient with small cell lung cancer: A case report and literature review.

Abstract

RATIONALE:

Sintilimab is a novel programmed cell death receptor-1 (PD-1) inhibitor approved in the treatment of classical Hodgkin's lymphoma and undergoing clinical trials for various malignancies. As a PD-1 inhibitor, sintilimab is known to cause autoimmune adverse events similar to other PD-1 inhibitors. Diabetic ketoacidosis (DKA) is a rare but severe adverse event of this therapy.

PATIENT CONCERNS:

We report a case of a 59-year-old man who developed DKA after 5 doses of sintilimab for small cell lung cancer. His fasting glycemia level was 14.07 mmol/L, urine ketone bodies were 4+, arterial blood pH was 7.271, bicarbonate was 12.3 mmol/L, and glycated hemoglobin (HbA1c) was 7.4%. Extended investigations revealed that fasting C-peptide was undetectable (<0.003 nmol/L).

DIAGNOSIS:

These laboratory investigations supported the diagnosis of fulminant type 1 diabetes mellitus, but no β-cell related antibodies were positive.

INTERVENTIONS:

After remission of DKA, he was treated with insulin therapy to acquire a normalization of glycemia and the disappearance of symptoms.

OUTCOMES:

Sintilimab was withheld after 6 cycles and was converted to durvalumab to sustain the therapeutic effect.

LESSONS:

This case and associated literature review illustrate the importance of educating and monitoring patients who start PD-1 inhibitor therapy regarding this potentially life-threatening complication.

• Authors: Xiaofei Huang, Mei Yang, Liu Wang, Libo Li, Xiaowei Zhong
• Journal: Medicine (Medicine (Baltimore)) Vol. 100 Issue 19 Pg. e25795 (May 14 2021) ISSN: 1536-5964 [Electronic] United States
• PMID: 34106616 (Publication Type: Case Reports, Journal Article, Review)
• Copyright: Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

Chemical References

• Antibodies, Monoclonal, Humanized
• Immune Checkpoint Inhibitors
• sintilimab

Topics

• Antibodies, Monoclonal, Humanized (adverse effects, therapeutic use)
• Diabetic Ketoacidosis (chemically induced, diagnosis)
• Humans
• Immune Checkpoint Inhibitors (adverse effects, therapeutic use)
• Lung Neoplasms (drug therapy)
• Male
• Middle Aged
• Small Cell Lung Carcinoma (drug therapy)