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Management of Acute Pancreatitis Associated With Checkpoint Inhibitors
Barbara Barnes Rogers1, Terri Cuddahy1, Carolyn Zawislak1
1Fox Chase Cancer Center, Philadelphia, Pennsylvania.
Journal of the Advanced Practitioner in Oncology
|February 5, 2021
Summary
Immune checkpoint inhibitors (ICIs) can cause rare pancreatitis, often with combined therapy. Early signs include elevated enzymes, but symptoms vary and don't always indicate severity. Further research is needed on optimal management strategies.
Area of Science:
- Oncology
- Immunology
- Gastroenterology
Background:
- Immune checkpoint inhibitors (ICIs) harness the immune system to treat cancer.
- Pancreatitis is a rare but serious immune-related adverse event (irAE) associated with ICI therapy.
- Combined ICI therapy is more frequently linked to pancreatitis than monotherapy.
Purpose of the Study:
- To review the presentation, diagnosis, and management of pancreatitis in patients receiving ICIs.
- To highlight the diagnostic challenges and current treatment strategies for ICI-associated pancreatitis.
- To identify gaps in knowledge regarding optimal management, particularly the role of steroids.
Main Methods:
- Literature review of studies on ICI-associated pancreatitis.
- Analysis of diagnostic criteria and clinical presentation.
- Evaluation of current management strategies, including supportive care, ICI discontinuation, and steroid use.
Main Results:
- Early pancreatitis may present solely with elevated lipase and amylase.
- Severe symptoms like abdominal pain, nausea, vomiting, or dyspnea can occur but do not always correlate with disease severity.
- Radiologic findings can be inconsistent in diagnosing ICI-associated pancreatitis.
- Discontinuation of ICIs is the primary intervention; steroid efficacy for pancreatitis specifically requires further investigation.
Conclusions:
- ICI-associated pancreatitis is a rare irAE requiring vigilant monitoring.
- Current management often mirrors acute pancreatitis protocols, with ICI cessation being key.
- The optimal role and efficacy of steroids in managing ICI-induced pancreatitis remain undetermined, necessitating further research.
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