Nista Enrico Celestino, De Lucia Sara Sofia, Archilei Sebastiano, Iaccarino Jacopo, Piccirilli Giulia, Nicoletti Alberto, Saviano Angela, Gasbarrini Antonio, Ojetti Veronica
Department of Medical and Surgical Sciences, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
Department of Emergency, Anesthesiological, and Reanimation Sciences, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
Metabolites. 2025 Jun 10;15(6):385. doi: 10.3390/metabo15060385.
The increasing use of immune checkpoint inhibitors (ICIs) in cancer treatment has led to a rise in immune-related adverse events (irAEs), including pancreatic injury. While current guidelines suggest that baseline monitoring of amylase and lipase levels is not necessary, it remains common in clinical settings, leading to confusion regarding their interpretation and management. This practice may lead to confusion, especially when patients exhibit isolated mild elevations of amylase and lipase, which may not always correlate with clinical pancreatitis. In contrast, significant elevations in these enzymes warrant further investigation, including imaging to assess the presence of pancreatitis. This review aims to provide a clearer framework for clinicians in managing ICI-induced pancreatic injury, promoting consistency in practice, and improving patient outcomes by reducing unnecessary interruptions to ICI therapy. It is critical to distinguish between the severity of pancreatitis to guide management. Considering the expected rise in the use of immune ICIs, it is crucial to increase awareness about the potential for pancreatic injury associated with these treatments.
免疫检查点抑制剂（ICIs）在癌症治疗中的使用日益增加，导致包括胰腺损伤在内的免疫相关不良事件（irAEs）增多。虽然目前的指南表明无需对淀粉酶和脂肪酶水平进行基线监测，但在临床环境中这一做法仍然普遍，导致对其解读和管理存在困惑。这种做法可能会导致混乱，尤其是当患者出现淀粉酶和脂肪酶单独轻度升高时，这并不总是与临床胰腺炎相关。相比之下，这些酶的显著升高需要进一步调查，包括进行成像检查以评估胰腺炎的存在。本综述旨在为临床医生管理ICI诱导的胰腺损伤提供更清晰的框架，促进实践的一致性，并通过减少对ICI治疗的不必要中断来改善患者预后。区分胰腺炎的严重程度以指导管理至关重要。考虑到免疫ICI使用量的预期增加，提高对这些治疗相关胰腺损伤可能性的认识至关重要。
