Immune checkpoint inhibitor (CPI)-induced diabetes mellitus (CPI-DM) is a rare immune-related adverse event (irAE). Patients and providers fear that continuing CPIs puts patients at risk for additional irAEs and thus may discontinue therapy. Currently, there are little data to inform this decision. Therefore, this study aims to elucidate whether discontinuing CPIs after diagnosis of CPI-DM impacts the development of future irAEs and cancer outcomes such as progression and death. Patients who developed CPI-DM during cancer treatment at UCSF from 1 July 2015 to 5 July 2023 were analyzed for cancer outcomes and irAE development. Fisher’s exact tests, Studentt-tests, Kaplan–Meier methods, and Cox regression were used as appropriate. Of the 43 patients with CPI-DM, 20 (47%) resumed CPIs within 90 days of the irAE, 4 (9%) patients restarted after 90 days, and 19 (44%) patients never restarted. Subsequent irAEs were diagnosed in 9 of 24 (38%) who resumed CPIs and 3 of 19 (16%) who discontinued CPIs (p= 0.17). There was no significant difference in death (p= 0.74) or cancer progression (p= 0.55) between these two groups. While our single-institution study did not show worse cancer outcomes after discontinuing CPIs, many variables can impact outcomes, which our study was not adequately powered to evaluate. A nuanced approach is needed to decide whether to continue CPI treatment after a severe irAE like CPI-DM.
免疫检查点抑制剂（CPI）诱发的糖尿病（CPI-DM）是一种罕见的免疫相关不良事件（irAE）。患者和医疗提供者担心继续使用CPI会使患者面临发生其他irAE的风险，因此可能中止治疗。目前，关于这一决策的指导数据极为有限。本研究旨在阐明，在确诊CPI-DM后停用CPI是否会影响后续irAE的发生以及癌症进展和死亡等临床结局。本研究分析了2015年7月1日至2023年7月5日期间在加州大学旧金山分校接受癌症治疗期间发生CPI-DM的患者，评估其癌症结局和irAE发生情况。研究采用Fisher精确检验、Student t检验、Kaplan-Meier法和Cox回归模型进行统计分析。在43例CPI-DM患者中，20例（47%）在irAE发生后90天内重启CPI治疗，4例（9%）在90天后重启，19例（44%）未再重启治疗。在重启CPI治疗的24例患者中，9例（38%）出现后续irAE；而在停用CPI的19例患者中，仅3例（16%）发生后续irAE（p=0.17）。两组患者在死亡率（p=0.74）和癌症进展率（p=0.55）方面无显著差异。尽管本单中心研究未显示停用CPI会导致更差的癌症结局，但多种变量可能影响结果，而本研究样本量不足以充分评估这些因素。对于CPI-DM这类严重irAE发生后是否继续CPI治疗，需要采取个体化的审慎决策策略。
肿瘤(癌症)患者之家