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Checkpoint inhibitor develops histological autoimmune pancreatitis like type 1 diabetes. A case report


MOJ Clinical & Medical Case Reports
Mazzucato M,1 Garelli S,1 Betterle C,2 Presotto F,3 De Riva C1

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Abstract

1.1 Background: Immune checkpoint inhibitors are new cancer drugs that act stimulating immune adapted response of patient to obtain tumor regression. Immunotherapy can generate immune-related adverse events involved all organs, in particular checkpoint inhibitors PD1/PDL1 can develop autoimmune type 1 diabetes. CASE 
1.2 Presentation: A 64 years old man affected by metastatic non-small cell lung carcinoma, after conventional therapy, was treated with pembrolizumab (a PD1/PDL1 checkpoint inhibitor): after ten weeks, he showed hyperglycemia with ketosis, stable reduced c-peptide, positive anti-glutamic acid decarboxylase antibodies therefore he was treated with insulin injection. The histological image of pancreas appeared like an immune-mediated insulitis. 
1.3 Conclusion: New guidelines are recently published to inform clinicians and patients about frequent immune adverse events of these new immunotherapies.

Keywords

immunotherapies, insulitis, pathophysiological , thyroid disfunction, hyperglycemia, anti-glutamic acid decarboxylase, autoimmune insulin-dependent

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