Department of Respiratory Diseases, Reims University Hospital, Reims, France.
Department of Respiratory Diseases, Charleville-Mézières Hospital, France.
Medicine (Baltimore). 2022 Jul 22;101(29):e29612. doi: 10.1097/MD.0000000000029612.
Despite clinical-proven benefits of immune checkpoint inhibitors (ICIs) on advanced lung cancer, rare but life-threatening immune-related adverse events (irAEs) have been reported. Pancreatitis is a rare irAE that can occur with any ICI.
A 53-year-old man with locally advanced non-small cell lung carcinoma was treated with radiochemotherapy and then durvalumab (anti-programmed cell death ligand 1 therapy). Twelve weeks after the beginning of ICI, he reported abdominal pain and anorexia. Blood test showed high level of lipase. Abdominal computed tomography revealed a swollen pancreas. These findings were confirmed by magnetic resonance cholangiopancreatography and biliopancreatic endoscopic ultrasonography.
Grade IV immune-related pancreatitis.
The patient was treated with corticosteroid therapy, resulting in clinical, radiological, and biological improvement.
During the first month, corticosteroid therapy could not be decreased under 1 mg/kg/d because of symptoms recurrence and lipasemia rerising. Four months after this episode, the patient died from acute ischemia of the lower limbs while he was on <20 mg/d of corticosteroid.
To the best of our knowledge, immune-related pancreatitis has been reported only with anti-programmed cell death 1 or anti-cytotoxic T lymphocyte antigen 4 therapies but never with anti-programmed cell death ligand 1 therapy. It is important to report such rare cases to improve diagnosis and management of irAEs.
尽管免疫检查点抑制剂（ICI）在晚期肺癌的临床治疗中被证实有效，但也有罕见但危及生命的免疫相关不良事件（irAE）的报道。胰腺炎是一种罕见的 irAE，可发生于任何 ICI。
一名 53 岁男性，患有局部晚期非小细胞肺癌，接受了放化疗和 durvalumab（抗程序性细胞死亡配体 1 治疗）治疗。ICI 开始后 12 周，他出现腹痛和食欲不振。血液检查显示脂肪酶水平升高。腹部 CT 显示胰腺肿胀。磁共振胰胆管成像和胆胰内镜超声检查证实了这些发现。
IV 级免疫相关胰腺炎。
患者接受了皮质类固醇治疗，临床、影像学和生物学均有所改善。
在第一个月，由于症状复发和脂肪酶再次升高，皮质类固醇治疗不能减少到 1mg/kg/d 以下。在这一事件发生四个月后，患者在接受<20mg/d 皮质类固醇治疗时因下肢急性缺血而死亡。
据我们所知，免疫相关胰腺炎仅与抗程序性细胞死亡 1 或抗细胞毒性 T 淋巴细胞抗原 4 治疗有关，从未与抗程序性细胞死亡配体 1 治疗有关。报告此类罕见病例对于改善 irAE 的诊断和管理非常重要。
