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Lipase elevation and type 1 diabetes mellitus related to immune checkpoint inhibitor therapy – A multicentre study of 90 patients from the German Dermatooncology Group
- Source :
- European Journal of Cancer. 149:1-10
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- Aim Immune checkpoint inhibition (ICI) triggers immune-related adverse events (irAEs). The relevance of lipase elevation remains unclear. Patients and methods Skin cancer patients with newly detected serum lipase elevation (at least twofold upper normal limit) or newly diagnosed type I diabetes mellitus upon ICI therapy were retrospectively collected at 14 German skin cancer centres. Results We identified 68 patients with lipase elevation occurring after a median time of 19 (range 1–181) weeks on ICI, 15 (22%) thereof had symptoms consistent with pancreatitis. Forty-seven patients (73%) had other irAE, mainly colitis. Discontinuation (n = 24, 35%) or interruption (n = 26, 38%) of ICI resulted in decrease of lipase after reinduction of ICI lipase levels increased again in 12 of 24 patients. In 18 patients (27%), ICI was continued unchanged, and in 12 (67%) of them, lipase levels normalised. Twenty-two patients were identified with newly diagnosed type I diabetes mellitus related to ICI, and 12 (55%) thereof had also lipase elevation mainly shortly before or after the diagnosis of diabetes. Fourteen (64%) patients had other irAE, mainly thyroiditis. Irrespective of lipase elevation, patients frequently showed a rapid onset with ketoacidosis, decreased c-peptide, and strongly increased blood glucose levels. Conclusion Increased serum lipase during ICI is often not associated with pancreatitis but with other irAE as possible cause. Therefore, it might be sufficient to regularly monitor blood glucose levels and perform further workup only in case of signs or symptoms of pancreatitis and/or exocrine pancreas insufficiency.
- Subjects :
- Adult
Blood Glucose
Male
0301 basic medicine
Cancer Research
medicine.medical_specialty
Skin Neoplasms
Time Factors
Medizin
Gastroenterology
Thyroiditis
Young Adult
03 medical and health sciences
0302 clinical medicine
Predictive Value of Tests
Germany
Internal medicine
Diabetes mellitus
medicine
Humans
Lipase
Adverse effect
Immune Checkpoint Inhibitors
Melanoma
Aged
Retrospective Studies
Aged, 80 and over
Type 1 diabetes
biology
business.industry
Diabetes
Immune checkpoint inhibitors
Immune-related adverse events
Ipilimumab
Nivolumab
Pancreatitis
PD-1 inhibitor
Pembrolizumab
Biomarkers
Diabetes Mellitus, Type 1
Exocrine Pancreatic Insufficiency
Female
Middle Aged
Treatment Outcome
Up-Regulation
medicine.disease
Ketoacidosis
030104 developmental biology
Oncology
030220 oncology & carcinogenesis
biology.protein
Skin cancer
business
Subjects
Details
- ISSN :
- 09598049
- Volume :
- 149
- Database :
- OpenAIRE
- Journal :
- European Journal of Cancer
- Accession number :
- edsair.doi.dedup.....f46f4bea919fbf1345c4e5a2fd89e7cc