Immune checkpoint inhibitors (CPIs) have revolutionized cancer treatment, enabling the immune system to better target tumours. However, they can lead to immune-related adverse events (irAEs), including CPI-induced diabetes mellitus (CPI-DM). CPI-DM is a rare but severe condition that may prompt clinicians to pause or discontinue treatment due to concerns about worsening irAEs and patient outcomes. This study aims to assess cancer progression, survival, and additional irAE risks in patients with CPI-DM who either resumed or discontinued CPI therapy.
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Figure 1 Flow chart depicting the clinical course of patients who continued on immune checkpoint inhibitors and who stopped immune checkpoint inhibitors at the time of immune checkpoint inhibitor diabetes.
A retrospective cohort of 43 CPI-DM patients treated at UCSF was examined. Patients were divided into groups based on CPI therapy continuation: those who resumed within 90 days, those who delayed resumption, and those who permanently discontinued treatment. Researchers analysed irAE occurrences, cancer progression, and overall survival, using statistical models, including Fisher’s exact tests, Kaplan-Meier methods, and Cox regression.
Of the 43 patients, 47% resumed CPI therapy promptly, 9% resumed after a delay, and 44% permanently discontinued treatment. Following CPI-DM onset, subsequent irAEs were reported in 38% of those who resumed CPIs and 16% of those who did not, though the difference was not statistically significant. Additionally, no significant differences in cancer progression or overall survival were observed between the groups.
This study suggests that resuming CPI therapy after CPI-DM does not significantly increase the risk of new irAEs or negatively impact cancer outcomes. However, due to the limited sample size, further research is needed to fully understand the safety of CPI continuation after CPI-DM. These findings may help guide clinicians and patients when making decisions on whether to resume CPI therapy following CPI-DM.
Summary by Faith Oluwamakinde
