Sintilimab-induced autoimmune diabetes mellitus manifesting as diabetic ketoacidosis in a patient with advanced esophageal squamous cell carcinoma

Excerpt

Esophageal cancer is sixth globally in mortality and seventh in prevalence in 2020. Approximately 90% of esophageal cancer cases in world are esophageal squamous cell carcinomas (ESCC), many of which are advanced at diagnosis. Immune checkpoint inhibitors (ICIs) and chemotherapy used together in the first-line treatment of ESCC have demonstrated excellent results and regulatory approval [1]. However, ICIs can cause immune-related adverse events (irAEs). There have been reports of involvement in a wide range of organs and tissues: the skin, cardiovascular system, digestive tract, lungs, liver, joints, and endocrine adverse effects. Yet, autoimmune diabetes mellitus and even diabetic ketoacidosis, which are typically brought on by ICIs, are uncommon and very rarely documented, particularly among ESCC patients. Sintilimab, as one of ICIs, can boost the immune system’s monitoring and prevents tumor-associated T cells from being able to trigger a defense response. And when treating advanced ESCC that can be surgically removed, sintilimab has a strong track record of success [2]. In this paper we report the first instance of recently diagnosed autoimmune diabetes mellitus (DM) and diabetic ketoacidosis (DKA) in an ESCC patient receiving sintilimab therapy, along with the antitumor effectiveness. …