Department of Spine Surgery, The First Hospital of Hunan University of Chinese Medicine, Changsha, 410007, Hunan, China.
College of pharmacy, Changsha Medical University, Changsha, 410219, Hunan, China.
Invest New Drugs. 2024 Aug;42(4):369-375. doi: 10.1007/s10637-024-01452-0. Epub 2024 Jun 3.
Acute pancreatitis (AP) is a rare adverse event of pembrolizumab with unclear clinical features. This study investigated the clinical features of pembrolizumab-induced AP to provide a reference for prevention and treatment. Case reports, case series and clinical studies of pembrolizumab-induced AP were collected by searching Chinese and English databases up to January 31, 2024. Thirty-one patients were included, with a median age of 59 years (range 39, 82). The median time from administration to onset of AP was 5.05 months (range 0.5, 16) and the median cycle was 7 cycles (range 1, 35). Twenty-two (71.0%) patients had elevated pancreatic amylase with a median value of 860 IU/L (range 105-12562), and 16 (51.6%) patients had elevated lipase with a median value of 282 IU/L (range 153-1034). Pancreatic biopsy showed neutrophil infiltration (9.7%) and lymphocyte infiltration (6.5%). Immunohistochemical staining showed CD8 dominated inflammatory infiltration (6.5%). The computed tomography showed diffuse enlargement (51.6%) and focal enlargement (51.6%) of the pancreas. Endoscopic ultrasound showed enlarged hypoechoic pancreas(16.1%). PET/CT showed increased FDG uptake (16.1%). The magnetic resonance cholangial pancreatography showed narrowing of main pancreatic duct (12.9%). AP symptoms and pancreatic enzymes improved after discontinuation of pembrolizumab and administration of steroids and infliximab. Clinicians should be aware that AP is a rare adverse reaction to pembrolizumab. Pembrolizumab induced AP can be initiated with steroids for control, and infliximab can be initiated with steroid-refractory AP.
急性胰腺炎（AP）是一种罕见的帕博利珠单抗不良反应，其临床特征尚不清楚。本研究旨在探讨帕博利珠单抗诱导的 AP 的临床特征，为预防和治疗提供参考。通过检索中国和英文数据库，收集截至 2024 年 1 月 31 日的帕博利珠单抗诱导的 AP 的病例报告、病例系列和临床研究。共纳入 31 例患者，中位年龄为 59 岁（范围 39-82 岁）。AP 发病中位时间为用药后 5.05 个月（范围 0.5-16），中位用药周期为 7 个周期（范围 1-35）。22 例（71.0%）患者的胰腺淀粉酶升高，中位数为 860IU/L（范围 105-12562），16 例（51.6%）患者的脂肪酶升高，中位数为 282IU/L（范围 153-1034）。胰腺活检示中性粒细胞浸润（9.7%）和淋巴细胞浸润（6.5%）。免疫组化染色示 CD8 主导的炎症浸润（6.5%）。CT 显示胰腺弥漫性肿大（51.6%）和局限性肿大（51.6%）。超声内镜显示胰腺低回声肿大（16.1%）。PET/CT 显示 FDG 摄取增加（16.1%）。磁共振胆胰管成像显示主胰管狭窄（12.9%）。停用帕博利珠单抗，给予激素和英夫利昔单抗治疗后，AP 症状和胰腺酶谱改善。临床医生应意识到，AP 是帕博利珠单抗的一种罕见不良反应。帕博利珠单抗诱导的 AP 可以先用激素控制，对激素治疗抵抗的 AP 可以用英夫利昔单抗治疗。
