Barnes-Jewish Hospital at Washington University in St. Louis St. Louis, MO, United States
Vanisha Patel, MD, Motaz Ashkar, MBBS, MSCI Barnes-Jewish Hospital at Washington University in St. Louis, St. Louis, MO
Introduction: Immune checkpoint inhibitors (ICI), such as nivolumab and pembrolizumab, can cause immune checkpoint inhibitor-induced pancreatic injury (ICIPI) which has a range of presentations from asymptomatic pancreatic lipase elevation to acute pancreatitis (AP). The overall incidence of pancreatic immune-related adverse events due to anti-PD-1/L1 agents is 0.5-4%.
Case Description/Methods: This case series describes the clinical presentation of five patients who underwent treatment with ICI and developed ICIPI. Four patients had pancreatic injury, of which three patients developed subsequent pancreatic atrophy and two were treated for exocrine pancreatic insufficiency. One patient was diagnosed with mild acute pancreatitis based on radiographic and laboratory criteria.
Discussion: ICIPI is a rare complication of anti-PD-1/L1 therapy that should be promptly recognized as it can lead to irreversible pancreatic atrophy, as well as endocrine and exocrine insufficiency. Future work can be geared to better understand the pathophysiology of ICIPI and inform the management of affected patients.
Figure: Computed tomography images of Patient #2 are depicted. Panel A shows normal-appearing pancreatic tissue (white arrow) prior to immune checkpoint inhibitor therapy. Panel B shows radiographic evidence of acute pancreatitis with fat stranding (red arrow) and a peripancreatic fluid collection (yellow arrow). Panel C shows pancreatic atrophy after stopping immune checkpoint inhibitor therapy (white arrow).
Vanisha Patel indicated no relevant financial relationships.
Motaz Ashkar indicated no relevant financial relationships.
Vanisha Patel, MD, Motaz Ashkar, MBBS, MSCI. P1135 - Pancreatic Immune-Related Adverse Events Due to Immune Checkpoint Inhibitor Therapy, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.