Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb 6;7(3):204-207.
doi: 10.1002/jgh3.12875. eCollection 2023 Mar.

Pancreatic adverse events in patients treated with immune checkpoint inhibitors

Caroline Hana  1 , Tauseef Rehman  1 , Kyeeun Park  1 , Carlos Carracedo Uribe  1 , Pyi Phyo Aung  1 , Brian Hunis  1 , Matthew Salzberg  1 , Jennifer Zikria  1 , Atif Hussein  1
Affiliations

Pancreatic adverse events in patients treated with immune checkpoint inhibitors

Caroline Hana et al. JGH Open. .

Abstract

Background and aim: The inhibition of cytotoxic T-lymphocyte associated antigen-4 (CTLA-4) and programmed cell death-1 (PD-1) has been a target for multiple drugs to enhance the T-cell antitumor activity. However, these immune checkpoint inhibitors (ICIs) come with a panel of immune-related adverse events (irAEs) that include mainly endocrine, skin, and gastrointestinal effects. We report seven cases of pancreatic irAEs in patients treated with ICIs at our institute.

Methods: This is a case series; data was collected through chart review by 3 different data collectors and was analyzed separately by 2 physicians.

Results: Of these seven cases, two had diabetic ketoacidosis (DKA), while five had pancreatitis diagnosed by a substantial rise in serum lipase. Pancreatitis was asymptomatic in two cases. A pancreatic biopsy in one case revealed type 2 autoimmune pancreatitis. The ICIs used included pembrolizumab, nivolumab, durvalumab, and avelumab. Treatment included steroids and holding the ICI therapy: three cases had complete resolution of pancreatitis while two cases required either a prolonged taper or a second course of prednisone for recurrence of pancreatitis. On the other hand, the DKA cases were treated with withdrawal of the ICI and starting insulin with no steroid therapy.

Conclusions: Pancreatitis and DKA are rare adverse events of ICIs that can be controlled by holding the ICI with or without starting steroids. Rechallenging the patient with the same ICI is possible in selected cases.

Keywords: diabetic ketoacidosis; immune checkpoint inhibitors; immune‐related adverse events; pancreatitis.

PubMed Disclaimer

References

    1. Chen L, Flies DB. Molecular mechanisms of T cell co‐stimulation and co‐inhibition. Nat. Rev. Immunol. 2013; 13: 227–42. - PMC - PubMed
    1. Vaddepally RK, Kharel P, Pandey R, Garje R, Chandra AB. Review of indications of FDA‐approved immune checkpoint inhibitors per NCCN guidelines with the level of evidence. Cancers. 2020; 12: 738. - PMC - PubMed
    1. Francisco LM, Salinas VH, Brown KE et al. PD‐L1 regulates the development, maintenance, and function of induced regulatory T cells. J. Exp. Med. 2009; 206: 3015–29. - PMC - PubMed
    1. Kwok G, Yau TC, Chiu JW, Tse E, Kwong YL. Pembrolizumab (Keytruda). Hum. Vaccin. Immunother. 2016; 12: 2777–89. - PMC - PubMed
    1. Topalian SL, Taube JM, Anders RA, Pardoll DM. Mechanism‐driven biomarkers to guide immune checkpoint blockade in cancer therapy. Nat. Rev. Cancer. 2016; 16: 275–87. - PMC - PubMed

LinkOut - more resources