1165P - Incidence of clinically relevant hyperglycaemia in patients with non-small cell lung cancer treated with immunotherapy

Background

In the last 5 years, the introduction of immune checkpoint inhibitors (ICPi) have dramatically improved treatment outcome in patient with non-small cell lung cancer (NSCLC) who do not harbour an actionable mutation. Whilst hyperglycaemia is known to have widespread immune modulating effects, little is known about the frequency of hyperglycaemia following treatment with a checkpoint inhibitor. Meanwhile, there is emerging evidence suggesting poorer outcomes in diabetic patients treated with ICPi.

Methods

Pharmacy records were used to identify patients from the lung unit who have received treatment with ICPi. The electronic patient's record (EPR) was used to identify those with hyperglycaemia at baseline or following treatment and to identify those with pre-diagnose diabetes. Hyperglycaemia was defined as a fasting glucose > 7 mmol/L or random glucose ≥ 11.1 mmol/L. Clinical and demographic data as well as the date of 1^st dose of checkpoint inhibitor, date 1^st elevated glucose level and date of radiologically confirmed progression or death or last contact were also obtained from patient's records. Glucose levels were analysed to one year after the cessation of checkpoint inhibitor therapy.

Results

A total of 213 NSCLC treated with immunotherapy were identified. Median age was 68 years (range 45-84) and patient were predominantly male (n=203). Most patients had an adenocarcinoma, 43% had a high PDL-1 expression (>50%) and 37% were treated with palliative intent with pembrolizumab monotherapy. Of the 169 without DM at baseline 10 (5.9%) developed glucose >11.1 in first 6 months of treatment; 5 received steroids, 2 had an infection, in 2 no clear cause found and settled spontaneously and only 1 ICPi induced DM was identified. Of the 43 with DM 23 (53%) developed glucose >11.1 in first 6 months of treatment.

Conclusions

Whilst ICPi induced diabetes is rare, treatment with ICPi in diabetic patients often results in clinically relevant hyperglycemia, potentially resulting in poorer treatment outcome. Strict glucose monitoring and treatment of hyperglycaemia might improve this. Further survival analyses and prospective studies are needed to investigate the effect of hyperglycaemia in this frail population.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.