암환자에서 Pembrolizumab 투여로 인한 혈당수치 변화 분석
Analysis of Pembrolizumab-induced Blood Glucose Level Change in Cancer Patients
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Background: Pembrolizumab, an anti-cancer drug, is known to increase the activity of the immune system, leading to side effectscalled immune-related adverse events (irAE), including type 1 diabetes. This study analyzed the correlation between blood glucoselevel and pembrolizumab administration and investigated the covariates that affect those changes in cancer treatment. Methods: Theinformation of 133 adult cancer patients was obtained from the electronic medical record (EMR) to identify the changes in randomblood glucose (RBG) levels during the pembrolizumab treatment. Subjects were classified into subgroups according to their baselineRBG level, history of diabetes, and the use of steroids, and linear regression analysis was conducted. In addition, a secondaryanalysis was performed within the group of subjects having a strong correlation to glycemic change, which was based on the Pearsoncorrelation coefficient being less than -0.7 or greater than +0.7. Univariate and multivariate logistic regressions were conducted toidentify the risk factors to glycemic increase. Results: The RBG level tended to descend without significant differences in totalpatients during the administration period of pembrolizumab. Despite the insignificance, the logistic regression analysis presents thatthe odds ratios of baseline RBG less than 130 mg/dL, prophylactic steroid use, and higher dose of pembrolizumab per cycle (mg/kg/cycle) were greater than 1. Conclusions: Prophylactic administration of steroids and a higher dose of pembrolizumab per cycle mayincrease the blood glucose level as irAE in cancer patients with a strong tendency to glycemic change.
Abstract
Background: Pembrolizumab, an anti-cancer drug, is known to increase the activity of the immune system, leading to side effectscalled immune-related adverse events (irAE), including type 1 diabetes. This study analyzed the correlation between blood glucoselevel and pembrolizumab administration and investigated the covariates that affect those changes in cancer treatment. Methods: Theinformation of 133 adult cancer patients was obtained from the electronic medical record (EMR) to identify the changes in randomblood glucose (RBG) levels during the pembrolizumab treatment. Subjects were classified into subgroups according to their baselineRBG level, history of diabetes, and the use of steroids, and linear regression analysis was conducted. In addition, a secondaryanalysis was performed within the group of subjects having a strong correlation to glycemic change, which was based on the Pearsoncorrelation coefficient being less than -0.7 or greater than +0.7. Univariate and multivariate logistic regressions were conducted toidentify the risk factors to glycemic increase. Results: The RBG level tended to descend without significant differences in totalpatients during the administration period of pembrolizumab. Despite the insignificance, the logistic regression analysis presents thatthe odds ratios of baseline RBG less than 130 mg/dL, prophylactic steroid use, and higher dose of pembrolizumab per cycle (mg/kg/cycle) were greater than 1. Conclusions: Prophylactic administration of steroids and a higher dose of pembrolizumab per cycle mayincrease the blood glucose level as irAE in cancer patients with a strong tendency to glycemic change.
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