S65 Distinct Imaging Patterns of Immune Checkpoint Inhibitor-Induced Acute Pancreatitis

Kondo, Jordan; Keraliya, Abhishek; Townsend, Matthew J.; Giobbie‐Hurder, Anita; Braschi‐Amirfarzan, Marta; Grover, Shilpa

doi:10.14309/01.ajg.0000856900.02139.50

Cited by 1 publication

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“…118 Imaging features vary and may include diffuse or focal interstitial pancreatic oedema with peripancreatic stranding, pancreatic enlargement without adjacent stranding or normal pancreatic appearance. [119][120][121] The Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 classify pancreatitis and lipase elevation, as summarised in Table 1. 69 Most retrospective cohort studies on ICI pancreatic injury to date have applied definitions based on the revised Atlanta classification 122 rather than the CTCAE.…”

Section: Epidemiology and Classificationmentioning

confidence: 99%

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Review article: Contemporary management of gastrointestinal, pancreatic and hepatic toxicities of immune checkpoint inhibitors

Townsend,

Benque,

et al. 2024

Aliment Pharmacol Ther

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SummaryBackgroundImmune checkpoint inhibitors (ICIs) are effective oncologic agents which frequently cause immune‐related adverse events (irAEs) which can impact multiple organ systems. Onco‐Gastroenterology is a novel and emerging subspecialty within gastroenterology focused on cancer treatment‐related complications. Gastroenterologists must be prepared to identify and manage diverse immune‐mediated toxicities including enterocolitis, hepatitis, pancreatitis and other ICI‐induced toxicities.AimTo provide a narrative review of the epidemiology, diagnostic evaluation and management of checkpoint inhibitor‐induced gastrointestinal and hepatic toxicities.MethodsWe searched Cochrane and PubMed databases for articles published through August 2023.ResultsGastrointestinal and hepatic irAEs include most commonly enterocolitis and hepatitis, but also pancreatitis, oesophagitis, gastritis, motility disorders (gastroparesis) and other rarer toxicities. Guidelines from the National Comprehensive Cancer Network, American Society of Clinical Oncology and European Society for Medical Oncology, in combination with emerging cohort and clinical trial data, offer strategies for management of ICI toxicities. Evaluation of irAEs severity by formal classification and clinical stability, and a thorough workup for alternative etiologies which may clinically mimic irAEs underlie initial management. Treatments include corticosteroids, biologics and other immunosuppressive agents plus supportive care; decisions on dosing, timing and choice of steroid adjuncts and potential for subsequent checkpoint inhibitor dosing are nuanced and toxicity‐specific.ConclusionsExpanding clinical trial and cohort data have clarified the epidemiology and clinical characteristics of gastrointestinal, pancreatic and hepatic toxicities of ICIs. Guidelines, though valuable, remain based principally on retrospective cohort data. Quality prospective, controlled studies may refine algorithms for treatment and potential immunotherapy rechallenge.

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Section: Epidemiology and Classificationmentioning

confidence: 99%

“…Fatal cases have been reported 118 . Imaging features vary and may include diffuse or focal interstitial pancreatic oedema with peripancreatic stranding, pancreatic enlargement without adjacent stranding or normal pancreatic appearance 119–121 …”

Section: Pancreatic Injurymentioning

confidence: 99%