Predictors of the Onset of Type 1 Diabetes Obtained from Real-World Data Analysis in Cancer Patients Treated with Immune Checkpoint Inhibitors.

Medications that target programmed cell death protein-1 (PD-1) have proven effective. However, blockade of PD-1/Programmed death-ligand 1(PD-L1) causes immune-related adverse events (irAEs). Characteristics of this irAE include many symptom, low in frequency, and difficulty in prevention. The key to a successful ICI-related treatment lies in the management of irAEs resulting from immune checkpoint inhibitor (ICI) treatment. Although it is difficult to predict irAE, we tried to extract features of irAE expression from analysis of real-world database. This study used data extracted from the Japan Adverse Drug Event Report (JADER) database to assess risk factors associated with serious side effects of irAE, type 1 diabetes (T1DM). The analysis targets were nivolumab, atezolizumab, durvalumab, and pembrolizumab, and the study period was from July 2014 to June 2019. Analysis of Japanese population data confirmed that being women and having melanoma were risk factors for developing ICI-related T1DM. Analysis using this database in combination with information on ICI-related T1DM provides information and guidelines that will help in the safer treatment of ICI in the future.

Is glue embolization safe and effective for gastrointestinal bleeding?

Transcatheter arterial embolization using N-butyl-2-cyanoacrylate (NBCA) for gastrointestinal arterial bleeding enables higher cessation rate and lower recurrent bleeding rate compared with conventional embolic materials including gelatin sponge, metallic coil, and polyvinyl alcohol (PVA) particle. Glue embolization is particularly effective in patients with coagulopathy. Even in the lower gastrointestinal tract, ischemic bowel complications by glue embolization are comparable to other agents. Glue embolization is also effective for arterial esophageal bleeding without any serious ischemic complications although the anatomy of the esophageal artery is complex and varied. For bleeding after abdominal surgery such as pancreaticoduodenectomy or hepatic lobectomy, interventional radiologists should be careful with indicating glue embolization because the presence of fewer collateral vessels can easily result in serious ischemic complications. Modified glue such as Glubran 2 (NBCA associated with methacryloxyfulfolane) can reduce the risk of ischemic complication due to its less thermal reaction, but the outcomes seem unsatisfactory.