Immune Checkpoint Inhibitor-Induced Pancreatic Injury (ICI-PI) in Adult Cancer Patients: A Systematic Review and...

Area of Science:

• Oncology
• Immunology
• Gastroenterology

Background:

• Immune checkpoint inhibitors (ICIs) are crucial cancer therapies.
• Immune checkpoint inhibitor-induced pancreatic injury (ICI-PI) is a rare but serious immunotoxicity.
• Limited data exists on ICI-PI's treatment and long-term outcomes.

Purpose of the Study:

• To assess the frequency, severity, and management of ICI-PI.
• To evaluate long-term complications and recurrence rates associated with ICI-PI.
• To analyze ICI-PI incidence across different ICI types and combination therapies.

Main Methods:

• Systematic literature search of PubMed, EMBASE, and Cochrane Library for ICI-PI studies.
• Inclusion of 25 retrospective studies with 48,704 patients diagnosed with solid malignancies.
• Proportional single-arm meta-analysis using a random effects model to determine outcomes.

Main Results:

• ICI-PI occurred in 3.60% of patients, with 59.45% experiencing grade ≥ 3 toxicity.
• Incidence rates varied: 1.99% for CTLA4, 5.01% for PD(L)1, and 7.44% for combination ICIs (p < 0.01).
• Chronic complications, primarily diabetes mellitus (89.45%) and exocrine pancreatic insufficiency (10.55%), affected 63.54% of patients.

Conclusions:

• ICI-PI is an infrequent but severe adverse event associated with ICI therapy.
• Patients experiencing ICI-PI face a high risk of long-term complications, notably diabetes mellitus and exocrine pancreatic insufficiency.
• Recurrence of ICI-PI is significant (27.2%) upon re-challenge with ICIs.