The American Society of Clinical Oncology (ASCO) has reviewed complications associated with immune checkpoint inhibitor therapy.
Patient selection: diabetes mellitus associated with therapy with an immune checkpoint inhibitor
Parameters:
(1) symptoms
(2) fasting glucose in mg/dL
(3) checkpoint inhibitor associated diabetes mellitus (CIADM)
(4) ability to perform activities of daily living (ADL)
Evidence of CIADM may include: urine ketones, serum ketones, elevated anion gap, anti-GAD, anti-islet cell antibodies, reduced C-peptide levels
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Symptoms
|
Fasting Glucose
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CIADM
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ADL
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Grade
|
|
none or mild
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> ULN to 160 mg/dL
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no evidence
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normal
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G1
|
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moderate
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161 to 250 mg/dL
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no ketoacidosis; antibodies may be present
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normal
|
G2
|
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severe, may be life threatening
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251 to 500 mg/dL
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ketoacidosis or metabolic derangement
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unable to perform
|
G3
|
|
severe, may be life threatening
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> 500 mg/dL
|
ketoacidosis or metabolic derangement
|
unable to perform
|
G4
|
The diagnosis needs to consider pre-existing diabetes, which may worsen after start of the immune checkpoint inhibitor.
