Management of Acute Pancreatitis Associated With Checkpoint Inhibitors

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.

Machine Learning Models Using Routinely Collected Clinical Data Offer Robust and Interpretable Predictions of 90-Day Unplanned Acute Care Use for Cancer Immunotherapy Patients

“…Although it was not our primary purpose for this study, we identified numerous factors associated with ACU for the population. Some factors associated with the development of irAEs requiring hospitalizations, such as type of ICI agents, 56 platelet count, 57 pre-existing lung, cardiovascular, 56 nutritional, 56 , 58 hyperchloremia, 59 , 60 and infection conditions, 61 are documented in the literature. Variation in red blood cell size and volume is, to our knowledge, not elucidated before and significantly contributes to the accuracy of our XGBT algorithm.…”

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“…The development of immune-mediated diabetes is estimated at 1% with elevated lipase and/or amylase levels being common with concurrent pancreatitis 13. A related but rare adverse effect that may present with type I diabetes is ICI-associated pancreatitis with a 1% incidence based on clinical trial data and 0.3%–3.9% based on studies,14 15 although it is likely more prevalent. There have also been several cases in the literature where patients developed type I diabetes with pancreatitis from immune checkpoint blockade 3 15 16.…”

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