演題抄録

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開催概要
開催回
第56回・2018年・横浜
 

nivolumabにより発症したケトアシドーシスを伴う急性発症1型糖尿病の2例

演題番号 : P108-2

[筆頭演者]
演者)和田 尚子:1 
[共同演者]
内 博史:1、蘆田 健二:2、古江 増隆:1

1:九州大学・皮膚科、2:九州大学病院・第3内科

 

Clinical Case 1: A 59 years old woman presented our hospital for the treatment of metastatic melanoma originated from the right palm. A lymph node metastasis invading the vessel appeared on the right elbow 20 years after tumor resection and axillar lymphadenectomy, and treatment with nivolumab (2mg/kg, q3wk) started. Although she had complete response (CR) three months after the therapy, she was carried to our hospital complaining of disturbance of consciousness 5 months after the therapy. Laboratory tests showed hyperglycemia and ketoacidosis, and she was diagnosed with type 1 diabetes mellitus (T1DM) induced by nivolumab. Although treatment with nivolumab was stopped after development of T1DM, she still keeps CR and continues treatment with insulin.
Clinical Case 2: A 66 years old woman presented our hospital for the treatment of metastatic melanoma originated from vagina. Celiac lymph node metastases appeared 3 years after total abdominal hysterectomy, bilateral salpingo-oophorectomy, and sentinel lymph node resection, and treatment with nivolumab (3mg/kg, q2wk) started. Although metastatic lymph nodes gradually decreased and she achieved partial response (PR), she felt malaise and nausea after administration of the 28th course of nivolumab. Laboratory tests showed hyperglycemia and ketoacidosis and she was diagnosed with nivolumab induced T1DM. Although treatment with nivolumab was stopped after development of T1DM, she still keeps PR and continues treatment with insulin.
Although most cases of nivolumab-induced T1DM were reported to be presented as fulminant T1DM, our cases satisfy the diagnostic criteria of the acute-onset T1DM, but not fulminant T1DM. Human leucocyte antigen (HLA) typing revealed that both patients have DRB1*09:01, which is not a fulminant T1DM sensitive genotype, but an acute-onset T1DM sensitive genotype. Although further studies are needed, an onset style of nivolumab-induced T1DM may vary according to HLA types.

キーワード

臓器別:皮膚

手法別:免疫療法

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