Korean J Clin Pharm.  2021 Sep;31(3):237-246. 10.24304/kjcp.2021.31.3.237.

Analysis of Pembrolizumab-induced Blood Glucose Level Change in Cancer Patients

• Jung HY
• Hong MS
• Jung WJ
• Choi SO
• Chae Jw
• Yun Hy

• KMID: 2520998
• DOI: http://doi.org/10.24304/kjcp.2021.31.3.237

Abstract

Background
Pembrolizumab, an anti-cancer drug, is known to increase the activity of the immune system, leading to side effects called immune-related adverse events (irAE), including type 1 diabetes. This study analyzed the correlation between blood glucose level and pembrolizumab administration and investigated the covariates that affect those changes in cancer treatment.
Methods
The information of 133 adult cancer patients was obtained from the electronic medical record (EMR) to identify the changes in random blood glucose (RBG) levels during the pembrolizumab treatment. Subjects were classified into subgroups according to their baseline RBG level, history of diabetes, and the use of steroids, and linear regression analysis was conducted. In addition, a secondary analysis was performed within the group of subjects having a strong correlation to glycemic change, which was based on the Pearson correlation coefficient being less than -0.7 or greater than +0.7. Univariate and multivariate logistic regressions were conducted to identify the risk factors to glycemic increase.
Results
The RBG level tended to descend without significant differences in total patients during the administration period of pembrolizumab. Despite the insignificance, the logistic regression analysis presents that the 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 may increase the blood glucose level as irAE in cancer patients with a strong tendency to glycemic change.

Keyword

Pembrolizumab; immune-related adverse events; blood glucose level; cancer