PD-1 or PD-L1 agent induced diabetes across National Cancer Institute trials

Analysis of the National Cancer Institute Cancer Therapy Evaluation Program database investigated adverse events reports related to diabetes, hyperglycemia, and acidosis in patients receiving anti-PD-1 or anti-PD-L1 agents (‘ICI-D’). Among 13,966 patients across 158 trials, the overall cumulative incidence of ICI-D was low (0.52 per 100 treated patients), but incidence varied by treatment type and was lower if patients were exposed to concurrent chemotherapy (0.65% without chemotherapy versus 0.26% with chemotherapy; OR 0.38; 95% CI 0.21-0.71) and higher if patients were exposed to combined immunotherapy (0.94% with combination chemotherapy versus 0.37% with PD-1/PD-L1 inhibitor monotherapy; 0R 2.68; 95% CI 1.69-4.24). The health care burden of ICI-D was high, with 90% requiring hospitalization at diagnosis and 43% requiring intensive care. The authors conclude that ICI-D is a rare but morbid condition that varies based on the combination of ICIs with other agents.