A case of doxorubicin and cyclophosphamide therapy-induced type 1 diabetes: a case report

• Published in: Journal of medical case reports Vol. 17; no. 1; p. 26
• Main Authors: Miyabayashi, Makoto, Onishi, Shunichiro, Yoshida, Tomohiko, Takemoto, Minoru
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 27-01-2023; BioMed Central; BMC
• Subjects: Analysis; Anthracyclines; Antibodies; Blood gas analysis; Blood gases; Blood sugar; Breast cancer; Cancer; Cancer therapies; Case Report; Case reports; Chemotherapy; Consciousness; Cyclophosphamide; Cyclophosphamide - adverse effects; Development and progression; Diabetes; Diabetes Mellitus, Type 1 - chemically induced; Diabetes Mellitus, Type 1 - drug therapy; Diabetes therapy; Diabetic Ketoacidosis; Doxorubicin; Doxorubicin - adverse effects; Drug dosages; Female; Glucose; Glutamate; Glycosylated hemoglobin; Health aspects; Hospitalization; Humans; Immune Checkpoint Inhibitors - adverse effects; Infections; Insulin; Insulin aspart; Middle Aged; Patients; Tazobactam; Type 1 diabetes; Type 2 diabetes; Viral antibodies; Japan; Type 1 diabetes; Doxorubicin; Cyclophosphamide
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-023-03755-x

Patients receiving immune checkpoint inhibitors have been reported to develop autoimmune endocrine diseases, including type 1 diabetes, although few drugs have been shown to induce type 1 diabetes. Additionally, it is important to note that drugs other than immune checkpoint inhibitors could lead to the development of type 1 diabetes.
A 54-year-old Filipino female patient underwent surgery for left-sided breast cancer. Postoperative chemotherapy was initiated, including doxorubicin (Adriamycin) and cyclophosphamide therapy. The patient was brought to our hospital by ambulance after consciousness disturbance following three courses of doxorubicin and cyclophosphamide therapy and was hospitalized. Her blood glucose and hemoglobin A1c levels were 1661 mg/dL and 11.9%, respectively. The patient was diagnosed with diabetic ketoacidosis after arterial blood gas analysis indicated a blood pH of 7.120. Her insulin secretion was impaired, and her anti-glutamic acid decarboxylase antibody test result was significantly positive.
The present case shows that doxorubicin and cyclophosphamide therapy may cause unexpected adverse responses, such as type 1 diabetes, though rarely, and highlights the importance of careful patient follow-up. This report is the first to present a case of type 1 diabetes that suddenly developed after doxorubicin and cyclophosphamide treatment.