Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands.
Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, GZ 's-Hertogenbosch, The Netherlands.
J Immunother. 2023 Sep 1;46(7):271-275. doi: 10.1097/CJI.0000000000000472. Epub 2023 May 23.
Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of various malignancies, but are associated with serious adverse events like pancreatitis. Current guidelines are limited to the first step in treating acute ICI-related pancreatitis with steroids but lack treatment advices for steroid dependent pancreatitis. We describe a case series of 3 patients who developed ICI-related pancreatitis with chronic features such as exocrine insufficiency and pancreatic atrophy at imaging. Our first case developed after treatment with pembrolizumab. The pancreatitis responded well after discontinuation of immunotherapy but imaging showed pancreatic atrophy and exocrine pancreatic insufficiency persisted. Cases 2 and 3 developed after treatment with nivolumab. In both, pancreatitis responded well to steroids. However during steroid tapering, pancreatitis recurred and the latter developed exocrine pancreatic insufficiency and pancreatic atrophy at imaging. Our cases demonstrate resemblances with autoimmune pancreatitis based on clinical and imaging findings. In line, both diseases are T-cell mediated and for autoimmune pancreatitis azathioprine is considered as maintenance therapy. Guidelines of other T-cell mediated diseases like ICI-related hepatitis suggest tacrolimus. After adding tacrolimus in case 2 and azathioprine in case 3, steroids could be completely tapered and no new episodes of pancreatitis have occurred. These findings support the idea that the treatment modalities for other T-cell mediated diseases are worthwhile options for steroid dependent ICI-related pancreatitis.
免疫检查点抑制剂 (ICIs) 彻底改变了多种恶性肿瘤的治疗方法，但也与胰腺炎等严重不良事件相关。目前的指南仅限于用类固醇治疗急性 ICI 相关胰腺炎的第一步，但缺乏对类固醇依赖型胰腺炎的治疗建议。我们描述了 3 例患者的病例系列，这些患者在影像学检查中表现出慢性特征，如外分泌功能不全和胰腺萎缩，与 ICI 相关的胰腺炎。我们的第一个病例发生在接受 pembrolizumab 治疗后。免疫治疗停止后，胰腺炎得到了很好的缓解，但影像学显示胰腺萎缩和外分泌胰腺功能不全仍然存在。病例 2 和病例 3 发生在接受 nivolumab 治疗后。在这两种情况下，胰腺炎对类固醇反应良好。然而，在类固醇减量过程中，胰腺炎复发，后者在影像学检查中出现外分泌胰腺功能不全和胰腺萎缩。我们的病例基于临床和影像学发现与自身免疫性胰腺炎相似。同样，这两种疾病都是 T 细胞介导的，对于自身免疫性胰腺炎，硫唑嘌呤被认为是维持治疗。其他 T 细胞介导的疾病，如 ICI 相关肝炎的指南建议使用他克莫司。在病例 2 中添加他克莫司，在病例 3 中添加硫唑嘌呤后，类固醇可以完全减量，并且没有发生新的胰腺炎发作。这些发现支持这样一种观点，即其他 T 细胞介导的疾病的治疗方法对于类固醇依赖型 ICI 相关胰腺炎是值得考虑的选择。
