Pembrolizumab‐related pancreatitis with elevation of pancreatic tumour markers

Abstract

Lung cancer immunotherapy is an effective treatment option; however, it can be hampered by adverse events, including pancreatitis, associated with excessive immune activation. Here, we report the case of a 70-year-old patient who presented with recurrent lung squamous carcinoma and was started with pembrolizumab treatment (200 mg every three weeks). The patient developed pembrolizumab-induced pancreatitis. After 14 months of pembrolizumab treatment, positron emission tomography-computed tomography showed a tumour-shaped, highly integrated lesion at the pancreatic head and significantly elevated tumour markers, including carbohydrate antigen 19-9 (149.3 U/mL), s-pancreas antigen-1 (44.7 U/mL), and duke pancreatic monoclonal antigen type 2 (412 U/mL). Pembrolizumabinduced immune-related pancreatitis was effectively treated with prednisolone 90 mg (1 mg/kg/day). Four months later, normal levels of the three specific tumour markers were detected, with improved pancreatic enzymes and radiographic findings. To our knowledge, this is the first reported case of immune-related pancreatitis with elevated pancreatic cancer-specific markers.

Fatal Immune Checkpoint Inhibitor-related Pancreatitis

“…In both studies, no fatal case was reported. Our literature search found 12 case reports of ICI-induced pancreatitis ( Table ) ( 10 - 21 ), and all patients improved with cessation of the ICIs or corticosteroid therapy.…”

“…Abu-Sbeih et al ( 9 ) reported that more than half of ICI-related pancreatic injury cases were asymptomatic, and typical CT findings were present in only 25%, even among symptomatic patients. As illustrated in Table , ICI-related pancreatitis could be asymptomatic even with abnormal laboratory and radiological abnormalities ( 11 , 15 , 21 ). In our case, the diagnosis was not difficult to make because the patient had epigastric pain, elevated pancreatic enzyme values, and fluid collection around the enlarged pancreas.…”

Pembrolizumab-induced Focal Pancreatitis Diagnosed by Endoscopic Ultrasound-guided Fine-needle Aspiration

“…Although the frequency of ICI-induced pancreatitis is lower than that of other irAEs, with its clinical characteris-tics still unclear, several case reports have been published (8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Table shows the clinical characteristics of the 10 cases of ICI-induced pancreatitis that have been reported.…”

A case of antiprogrammed death‐ligand 1 antibody‐induced multisystem immune‐related adverse events with pancreatitis and steroid‐resistant sclerosing cholangitis

“…This result was also observed in previous studies of sclerosing cholangitis and pancreatitis. [13][14][15]23 Thus, irAE pancreatitis may have a good response to PSL, in contrast to cholangitis.…”