Introduction: Pembrolizumab (Keytruda®) is a potent and selective humanized monoclonal immunoglobulin antibody that blocks programmed cell death-1 on T cells, augmenting the antitumor immune response. Pembrolizumab is an approved adjuvant therapy for treating metastatic melanoma.
Clinical Findings: A 75-year-old man with metastatic melanoma developed diabetic ketoacidosis before receiving a sixth cycle of pembrolizumab.
Clinical Course: He received intravenous insulin, fluids, and electrolyte repletion per the diabetic ketoacidosis protocol. He presented again to the emergency room with profound hyperglycemia 1 week after discharge. Following a second round of treatment, his home insulin regimen was titrated for better glycemic control, and pembrolizumab was discontinued.
Conclusions: As cases of diabetes associated with immune checkpoint inhibitor therapy are increasingly reported, challenges may include adequately managing diabetes long-term, preventing diabetic ketoacidosis, and discontinuing pembrolizumab due to immune-related adverse effects.
Khan, Sarosh and Sujanani, Sunam
"Diabetic Ketoacidosis Precipitated by Pembrolizumab: A Case Report on the Challenges of Long-term Management,"
Journal of Maine Medical Center: Vol. 4
, Article 8.
Available at: https://doi.org/10.46804/2641-2225.1100