Nwankwo Oluchukwu Chimuanya, Lara-Salazar Francisco Martin, Lara-Salazar Santiago, Abdulrahim Abdulrashid Onimisi, Chijioke Ijeoma, Singh Jyoti, Koradia Ikhlaq, Gomez Nicole M, Prakash Rohit, Gopagoni Ragini, Joshi Megha, Rai Manju
Internal Medicine, National Pirogov Memorial Medical University, Vinnytsia, UKR.
Internal Medicine, Universidad Autónoma de Guadalajara Facultad de Medicina Guadalajara, Zapopan, MEX.
Cureus. 2024 Aug 28;16(8):e68043. doi: 10.7759/cureus.68043. eCollection 2024 Aug.
Immune checkpoint inhibitors (ICIs) are an approved therapy for the management of various advanced neoplasms. Limited reviews focus on the influence of this therapy resulting in pancreatitis. This review discusses the relationship between ICIs and their effects on the pancreas, including the incidence of pancreatitis, immunotherapy, programmed cell death 1 (PD-1) receptors, driver mutations, programmed death ligand 1 (PD-L1), and immune-related adverse events. Additionally, it focuses on the clinical presentations, diagnosis, case studies, and mechanisms by which ICIs activate different pathways to cause pancreatitis. We conducted a comprehensive literature search using PubMed, Cochrane Library, and Google Scholar databases to identify relevant studies on ICI-associated pancreatitis. The review explores the incidence and epidemiology of ICI-induced pancreatitis, its clinical presentation, diagnostic criteria, and management strategies.The overall incidence of ICI-induced pancreatitis is estimated at 1-2%, with higher rates observed in combination therapy. Clinical presentations range from asymptomatic enzyme elevations to severe pancreatitis. Diagnosis relies on a combination of clinical symptoms, elevated pancreatic enzymes, and imaging findings, with MRI and endoscopic ultrasound showing promise in early detection. Management strategies include IV fluid administration, pain control, and nutritional support. The efficacy of corticosteroids remains controversial, and alternative immunosuppressants are being explored for steroid-refractory cases. Long-term monitoring is crucial due to the risk of chronic pancreatitis and pancreatic insufficiency. This review highlights the need for further research to elucidate the exact mechanisms of ICI-associated pancreatic injury, develop predictive biomarkers, and refine treatment protocols. As ICI use continues to expand, a thorough understanding of this adverse event is essential for optimizing patient care and outcomes in cancer immunotherapy.
免疫检查点抑制剂（ICIs）是一种已获批准用于治疗各种晚期肿瘤的疗法。有限的综述关注这种疗法导致胰腺炎的影响。本综述讨论了ICIs与它们对胰腺的影响之间的关系，包括胰腺炎的发病率、免疫疗法、程序性细胞死亡1（PD-1）受体、驱动基因突变、程序性死亡配体1（PD-L1）以及免疫相关不良事件。此外，它还关注ICIs激活不同途径导致胰腺炎的临床表现、诊断、病例研究和机制。我们使用PubMed、Cochrane图书馆和谷歌学术数据库进行了全面的文献检索，以识别关于ICI相关胰腺炎的相关研究。该综述探讨了ICI诱导的胰腺炎的发病率和流行病学、其临床表现、诊断标准和管理策略。ICI诱导的胰腺炎的总体发病率估计为1%-2%，联合治疗中观察到的发病率更高。临床表现从无症状的酶升高到严重胰腺炎不等。诊断依赖于临床症状、胰腺酶升高和影像学检查结果的综合判断，MRI和内镜超声在早期检测中显示出前景。管理策略包括静脉输液、疼痛控制和营养支持。皮质类固醇的疗效仍存在争议，正在探索用于类固醇难治性病例的替代免疫抑制剂。由于存在慢性胰腺炎和胰腺功能不全的风险，长期监测至关重要。本综述强调需要进一步研究以阐明ICI相关胰腺损伤的确切机制、开发预测性生物标志物并完善治疗方案。随着ICI的使用不断扩大，全面了解这一不良事件对于优化癌症免疫治疗中的患者护理和治疗结果至关重要。
