Cancer patients who develop acute pancreatitis (AP) due to immune checkpoint inhibitor (ICI) treatment may require abdominal imaging for diagnosis and should be monitored for exocrine pancreatic insufficiency, according to researchers.
The researchers found evidence to suggest that a minority of hyperlipasemia and AP cases are caused by ICIs. However, some patients with ICI-induced AP do not present with symptoms and may therefore require imaging for diagnosis. Patients with ICI-induced AP are also more likely to develop exocrine pancreatic insufficiency.
The researchers reported these findings in the Journal of the National Comprehensive Cancer Network.
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This study included 6450 cancer patients who had received at least 1 dose of an ICI, and 364 of these patients developed hyperlipasemia during treatment. The 364 patients most commonly had melanoma (24%), lung cancer (18%), renal cancer (8%), bladder cancer (6%), colorectal cancer (5%), or ovarian cancer (5%).
The researchers determined that 105 of the hyperlipasemia cases (29%) were related to ICI use. Other causes of hyperlipasemia included malignant biliary obstruction and metastasis (19%), bowel obstruction/ischemia (15%), extrapancreatic ICI-induced immune-related adverse events (irAEs) such as enterocolitis and gastritis (11%), and infectious enterocolitis (6%).
Of the 105 patients with ICI-related hyperlipasemia, 27 (26%) were found to have ICI-induced AP. Four of these 27 patients (15%) “presented asymptomatically with hyperlipasemia and pancreatic inflammation on imaging,” the researchers noted.
In a multivariable analysis, patients with ICI-induced AP were more likely than those without ICI-induced AP to have had 1 or more nonpancreatic irAEs (1 additional irAE: odds ratio [OR], 8.51; 95% CI, 2.69-37.73; 2 or more irAEs: OR, 5.43; 95% CI, 1.47-26.03; P <.01).
Patients with ICI-induced AP were also more likely to have melanoma than other cancers (OR, 2.51; 95% CI, 0.99-6.31; P =.05).
When compared to patients with ICI-induced hyperlipasemia who did not develop ICI-induced AP, patients who did have ICI-induced AP were more likely to:
- Have exocrine pancreatic insufficiency (11% vs 0%; P =.02)
- Require steroids (74% vs 4%; P <.01)
- Require intravenous fluids (85% vs 10%; P <.01)
- Be hospitalized (89% vs 9%; P <.01)
- Stop ICIs permanently due to pancreatic injury (70% vs 3% P <.01).
“ICI-[induced] AP and hyperlipasemia present variably and must be distinguished from clinical mimics,” the researchers concluded. “The clinical characteristics and relative frequencies reported here may help clinicians discern [ICI-induced pancreatic injury] from competing causes and facilitate early initiation of treatment.”
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Reference
Townsend MJ, Liu M, Giobbie-Hurder A, et al. Pancreatitis and hyperlipasemia in the setting of immune checkpoint inhibitor therapy. J Natl Compr Canc Netw. 2023;21(8):831-840.e3. doi:10.6004/jnccn.2023.7034
