Department of Dermatology, University of Leipzig Medical Center, Leipzig, Germany.
Melanoma Res. 2019 Oct;29(5):549-552. doi: 10.1097/CMR.0000000000000611.
Recognizing and treating rare checkpoint inhibitor related adverse events may be a clinical challenge in melanoma therapy. One of rather rare affected organs is the pancreas. Immune-related pancreatitis is difficult to recognize due to its variable clinical characteristics. Asymptomatic elevations of serum lipase and/or amylase during therapy with immune-checkpoint blockade impede the diagnostic process. We present a patient who developed an immune-related pancreatitis within the first 4 months of immunotherapy. Treatment with high dose systemic glucocorticosteroids with very slow tapering over a total period of 6.5 months was necessary to keep the patient symptom free as well as to maintain long-term normalization of serum lipase. Checkpoint blockade related pancreatitis may occur as acute or chronic disease and may lack any radiographic signs. As in our case, very slow tapering of initially high dose systemic glucocorticosteroids seems to be a crucial requirement for lasting recovery. Even after successful treatment, late-onset secondary pancreatic insufficiency may occur and patients have to be followed up at regular intervals. Restarting immunotherapy after resolution of immune-related pancreatitis is possible but needs careful risk-benefit consideration.
识别和治疗罕见的检查点抑制剂相关不良反应可能是黑色素瘤治疗中的一个临床挑战。胰腺是受影响的罕见器官之一。由于其临床表现多变，免疫相关性胰腺炎难以识别。在免疫检查点阻断治疗期间，血清脂肪酶和/或淀粉酶的无症状升高会阻碍诊断过程。我们报告了一名患者，他在免疫治疗的头 4 个月内发生了免疫相关性胰腺炎。需要用大剂量全身糖皮质激素治疗，总疗程为 6.5 个月，逐渐缓慢减量，以保持患者无症状，并维持血清脂肪酶的长期正常化。与检查点阻断相关的胰腺炎可表现为急性或慢性疾病，并且可能缺乏任何影像学征象。就像我们的病例一样，最初使用大剂量全身糖皮质激素逐渐缓慢减量似乎是持久恢复的关键要求。即使在成功治疗后，也可能发生迟发性继发性胰腺功能不全，患者需要定期随访。在免疫相关性胰腺炎缓解后重新开始免疫治疗是可能的，但需要仔细考虑风险效益。
