Use pembrolizumab may cause acute and severe adverse reactions: a case report and review

Introduction:Immune checkpoint inhibitors (ICIs) have emerged as pivotal therapeutics for personalized cancer treatment. Programmed death protein receptor 1/ligand 1 (PD-1/PD-L1) inhibitors represent the most extensively utilized immune checkpoint blockade agents. Among these, pembrolizumab has gained approval for advanced cancer management. By engaging with PD-1 on T cells, pembrolizumab orchestrates the immune response against tumor cells; however, it is also associated with a spectrum of adverse events, including an infrequent manifestation of fulminant type 1 diabetes.Case presentation:ICIs-induced fulminant type 1 diabetes mellitus (FT1DM) in breast cancer patients has been rarely documented. To provide further evidence of such adverse events, this paper presents the case of a 58-year-old Chinese patient with breast cancer and multi-organ metastasis, who had no prior history of diabetes. Following five courses of pembrolizumab, she developed severe fulminant type 1 diabetes accompanied by ketoacidosis.Discussion:Pembrolizumab is commonly utilized in the treatment of patients with advanced cancer. While it offers significant benefits to patients, it can also lead to numerous adverse reactions, with immune-related diabetes being the most prevalent among them as a result of pembrolizumab usage.Conclusions:FT1DM complicated with ketoacidosis represents a critical and potentially life-threatening medical condition, necessitating immediate attention. Our case study underscores the inherent risks associated with pembrolizumab administration and offers valuable insights for its safe utilization in patients.