Grand Rounds

Management of Acute Pancreatitis Associated With Checkpoint Inhibitors

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ABSTRACT

Pancreatitis is a rare immune-related adverse event (irAE) associated with the use of immune checkpoint inhibitors (ICIs). It is more often associated with combined immunotherapy than by any single agent. Early signs of pancreatitis may only include elevation of lipase and amylase. Additional symptoms associated with pancreatitis include symptoms such as severe epigastric abdominal pain (that may radiate to the back, chest, or flank), nausea and/or vomiting, or dyspnea, and may indicate more advanced disease. Some researchers note that the presence of symptoms is not an indicator of more severe pancreatitis or long-term adverse outcomes. Radiologic changes can be useful in the diagnostic workup of ICI-associated pancreatitis, but radiologic tests may not show any changes in some patients with active pancreatitis. The management of ICI-associated pancreatitis can include those interventions used to manage acute pancreatitis (e.g., IV fluids, holding the agent, antibiotics, and steroids). The National Comprehensive Cancer Network Guidelines only recommend intervention for moderate to severe pancreatitis. Holding the associated ICI(s) is the most commonly used intervention when patients experience pancreatitis that is thought to be related to ICIs. Steroids are usually used in the management of irAEs associated with checkpoint inhibitors; however, there are no studies available at this time to indicate that this is the best method to treat pancreatitis associated with ICIs. Additional studies are needed to determine if steroids are the best method to manage irAE-associated pancreatitis or if additional management strategies are important in the management of pancreatitis in patients receiving checkpoint inhibitors. 

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