University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
Curr Gastroenterol Rep. 2023 Oct;25(10):255-259. doi: 10.1007/s11894-023-00885-6. Epub 2023 Oct 17.
Immune checkpoint inhibitors (ICI) have revolutionized cancer care and work primarily by blocking CTLA-4 (cytotoxic T-lymphocyte-associated protein 4), and/or PD-1 (programmed cell death protein 1), and/or PD-L1 (programmed death-ligand 1), thereby providing highly efficacious anti-tumor activity. However, this unmitigated immune response can also trigger immune related adverse events (irAEs) in multiple organs, with pancreatic irAEs (now referred to as type 3 Autoimmune pancreatitis (AIP) being infrequent.
Type 3 AIP is a drug-induced, immune mediated progressive inflammatory disease of the pancreas that may have variable clinical presentations viz., an asymptomatic pancreatic enzyme elevation, incidental imaging evidence of pancreatitis, painful pancreatitis, or any combination of these subtypes. Management is largely supportive with intravenous fluid hydration, pain control and holding the inciting medication. Steroids have not been shown to demonstrate a clear benefit in acute management. A rapid development pancreatic atrophy is observed on imaging as early as 1 year post initial injury. Type 3 AIP is a chronic inflammatory disease of the pancreas that though predominantly asymptomatic and mild in severity can lead to rapid organ volume loss regardless of type of clinical presentation and despite steroid therapy.
免疫检查点抑制剂（ICI）改变了癌症治疗方式，主要通过阻断 CTLA-4（细胞毒性 T 淋巴细胞相关蛋白 4）和/或 PD-1（程序性细胞死亡蛋白 1）和/或 PD-L1（程序性死亡配体 1），从而提供高效的抗肿瘤活性。然而，这种不受控制的免疫反应也会在多个器官引发免疫相关不良反应（irAEs），胰腺 irAEs（现在称为 3 型自身免疫性胰腺炎（AIP））并不常见。
3 型 AIP 是一种药物诱导的、免疫介导的胰腺进行性炎症性疾病，其临床表现可能多种多样，如无症状的胰腺酶升高、偶然发现的胰腺炎影像学证据、胰腺炎疼痛或这些亚型的任何组合。治疗主要是支持性的，包括静脉补液、止痛和停用引发疾病的药物。皮质类固醇在急性治疗中并没有显示出明显的益处。在初始损伤后 1 年内，影像学上可观察到胰腺迅速萎缩。3 型 AIP 是一种慢性胰腺炎症性疾病，尽管主要无症状且病情较轻，但无论临床表现类型如何，即使进行皮质类固醇治疗，也会导致快速的器官体积丧失。
