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Case Rep Oncol. 2017 Oct 17;10(3):897-909. doi: 10.1159/000480634. eCollection 2017 Sep-Dec.

Immune Checkpoint Inhibitor-Associated Type 1 Diabetes Mellitus: Case Series, Review of the Literature, and Optimal Management.

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Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Division of Endocrinology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.


With the introduction of immune checkpoint inhibitors into clinical practice, various autoimmune toxicities have been described. Antibodies targeting the receptor:ligand pairing of programmed death receptor-1 (PD-1) and its cognate ligand programmed death-ligand 1 (PD-L1) in rare reports have been associated with autoimmune diabetes mellitus. We report 2 cases of rapid-onset, insulin-dependent, type 1 diabetes mellitus in the setting of administration of nivolumab, a fully human monoclonal antibody to PD-1, and atezolizumab, a humanized monoclonal antibody to PD-L1. This appears to be the first report of autoimmune diabetes mellitus associated with atezolizumab. In addition, we provide a brief review of similar cases reported in the literature and a discussion of potential mechanisms for this phenomenon and propose a diagnostic and treatment algorithm.


Autoimmunity; Checkpoint inhibitor; Diabetes mellitus; Immunology; Immunotherapy

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