In a study reported in JAMA Oncology, Ruiz-Esteves et al identified risks for immune checkpoint inhibitor–induced diabetes in patients with cancer.
Study Details
The retrospective cohort study involved data from 14,328 adult patients with cancer treated with immune checkpoint inhibitors in the Mass General Brigham system between July 2010 and January 2022.
Key Findings
Among the 14,328 patients (median age = 66 years), immune checkpoint inhibitor–induced diabetes was identified in 64 (0.45%), an incidence of 124.8 cases per 100,000 person-years.
Clinical factors associated with increased risk of immune checkpoint inhibitor–induced diabetes were preexisting type 2 diabetes (odds ratio [OR] = 5.91, 95% confidence interval [CI] = 3.34-10.45) and treatment with combination immune checkpoint inhibitors (OR = 2.57, 95% CI = 1.44-4.59).
A total of 862 patients had type 1 diabetes polygenic risk score (T1D GRS2) data available. T1D GRS2 was associated with immune checkpoint inhibitor–induced diabetes risk, with an OR of 4.4 (95% CI = 1.8-10.5) for the top vs bottom decile of scores. The investigators noted that this finding indicates a genetic association between spontaneous autoimmunity and immune-related adverse events.
Three main phenotypes of immune checkpoint inhibitor–induced diabetes were identified based on presence of autoantibodies and residual pancreas function (β-cell function measured as C-peptide levels; the phenotype of autoantibody-positive and poor function (low or undetectable C-peptide level) was characterized by more fulminant presentation.
The investigators concluded: “The results of this analysis of 14 328 [immune checkpoint inhibitor–]treated patients followed up from [immune checkpoint inhibitor] initiation determined the incidence, risk factors and clinical spectrum of [immune checkpoint inhibitor–]induced diabetes. Widespread implementation of this approach across organ-specific [immune-related adverse events] may enhance diagnosis and management of these conditions, and this becomes especially pertinent as [immune checkpoint inhibitor] treatment rapidly expands to treat a wide spectrum of cancers and is used at earlier stages of treatment.”
Michelle Rengarajan, MD, PhD, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, is the corresponding author for the JAMA Oncology article.
DISCLOSURE: The study was supported by a grant from the National Institutes of Health. For full disclosures of the study authors, visit jamanetwork.com.
