Pancreatic injury in patients treated with immune checkpoint inhibitors: a retrospective multicenterstudy

• Published in: Journal of gastroenterology Vol. 59; no. 5; pp. 424 - 433
• Main Authors: Nagao, Kae, Sakai, Arata, Tsumura, Hidetaka, Iemoto, Takao, Hirata, Yuichi, Hori, Hitomi, Ogisu, Kyohei, Kakuyama, Saori, Ikegawa, Takuya, Hirata, Tamaki, Ezaki, Takeshi, Furumatsu, Keisuke, Yamanaka, Kodai, Kato, Takao, Fujigaki, Seiji, Tanaka, Hidenori, Yagi, Yosuke, Tanaka, Takeshi, Kobayashi, Takashi, Masuda, Atsuhiro, Shiomi, Hideyuki, Kodama, Yuzo
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01-05-2024; Springer Nature B.V
• Subjects: Abdominal Surgery; Biliary Tract; Colorectal Surgery; Enzymes; Gastroenterology; Hepatology; Immune checkpoint inhibitors; Medical records; Medicine; Medicine & Public Health; Original Article―Liver; Original ―Liver, Pancreas, and Biliary Tract; Pancreas; Pancreatitis; Patients; Risk factors; Steroids; Surgical Oncology; Immune checkpoint inhibitors; Malignant tumors; Pancreatic injury; Pancreatitis
• ISSN: 0944-1174; 1435-5922
• DOI: 10.1007/s00535-024-02083-1

Background
Immune checkpoint inhibitor-related pancreatic injury (ICI-PI) is a rare occurrence, which has not been reported in detail. We conducted a retrospective multicenter study to determine the clinical characteristics, risk factors, and treatment of ICI-PI.
Methods
We reviewed the medical records of patients who received ICIs for malignant tumors between April 2014 and April 2019 at 16 participating hospitals. Patients with elevated pancreatic enzymes or pancreatitis were identified and classified using the Common terminology Criteria for Adverse Events (CTCAE) ver.5.0). The number of patients with pancreatic enzyme elevation was determined and those with pancreatic enzyme elevation of ≥ grade 3 according to CTCAE ver.5.0, or pancreatitis underwent detailed analysis for ICI-PI.
Results
The study enrolled 1069 patients. Nineteen patients (1.8%) had ICI-PI, 5 (0.5%) of whom also had pancreatitis. Four patients had mild pancreatitis, whereas 1 patient had severe pancreatitis, culminating in death. Steroid therapy was administered to 7 of 19 patients, which led to ICI-PI improvement in 5 patients. On the other hand, ICI-PI improved in 9 of 12 patients who were not administered steroid therapy. Six of the 14 patients with ICI-PI improvement were rechallenged with ICI, and ICI-PI relapse occurred in only 1 patient (16.7%), which improved with ICI discontinuation and steroid therapy.
Conclusions
ICI-PI is a rare occurrence, with a low incidence of pancreatitis, which followed a very serious course in one patient. Although the benefit of steroid therapy for ICI-PI is unclear, ICI rechallenge is acceptable after improvement of ICI-PI without pancreatitis.