Immune-related colitis and pancreatitis treated with infliximab

Immunomodulators for Steroid-Dependent Recurrent Acute Pancreatitis After Immune Checkpoint Inhibitor Therapy: A Case Series

One to 2% of patients undergoing immune checkpoint inhibitor (ICI) therapy develop ICI-induced pancreatitis (ICI-IP). A small subset of these patients develop recurrent pancreatitis, even after discontinuation of ICI therapy. This case series presents 2 patients with recurrent steroid-responsive ICI-IP who were managed with immunomodulators as steroid-sparing agents. Both patients were maintained on immunomodulators for approximately 2 years before discontinuation of the agents, with no further recurrence or complications of pancreatitis. This case series highlights the use of mycophenolate mofetil and azathioprine for the management of recurrent ICI-IP.

Systematic review of immune checkpoint inhibitor-related gastrointestinal, hepatobiliary, and pancreatic adverse events

Gastrointestinal immune-related adverse events (GI irAEs) are common manifestations of immune checkpoint inhibitor (ICI) toxicity. We present a comprehensive systematic review of the incidence, management, and clinical course of irAEs across the entire GI system, including the luminal GI tract, liver, and pancreas. MEDLINE, Embase, Web of Science Core Collection, and Cochrane Library were used to conduct this review. All studies pertaining to GI irAEs were included. Both abstracts and full manuscripts were eligible if they included human subjects and were written in the English language. Articles not available in English, animal studies, or research not specific to GI toxicity of immunotherapy were excluded. We excluded certain article types depending on whether stronger evidence was available in the literature for a specific toxicity, for example, if prospective studies were available on a topic, retrospective studies and case reports were excluded. We extracted a final 166 articles for our review and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for data reporting. Risk of bias tools were not used to evaluate the extracted studies given the narrative nature of this manuscript, but each study was critically appraised by the manuscript writer. We detail the incidence, presentation, evaluation, management, and outcomes of the various GI toxicities that may arise with ICI therapy. Specifically, we discuss the characteristics of upper GI toxicity (esophagitis and gastroenteritis), lower GI toxicity (colitis), hepatobiliary inflammation, pancreatitis, and rarer forms of GI toxicity. We hope this review serves as a useful and accessible clinical tool that helps physicians familiarize themselves with the nuances of gastrointestinal/hepatic/pancreatic ICI toxicity diagnosis and management.

Increasing Trends in the Pancreatitis Risk With Tumor Necrosis Factor Inhibitor Use

Tumor necrosis factor (TNF) inhibitors are a class of pharmacologic agents used to treat a wide range of immunologic diseases. We present a systematic study of the pancreatitis risk with TNF inhibitor use through a retrospective case-control design disproportionality analysis of the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database, with data ranging from the fourth quarter of 2012 (2012 Q4) to the second quarter of 2024 (2024 Q2). Our analysis reveals an increasing trend in the pancreatitis risk with TNF inhibitors when stratified by year, with all of the TNF inhibitors studied exhibiting significant association with pancreatitis in the year 2023. Furthermore, these results hold even when controlling for sex, age, concurrent use of azathioprine, and the indication for treatment. Our findings flag the necessity for a careful investigation and monitoring of pancreatitis risk in patients undergoing TNF inhibitor therapy, especially in recent years.

Colitis due to cancer treatment with immune check-point inhibitors - review of literature and presentation of clinical cases

Treatment with immune checkpoint inhibitors is effective in various cancers, but may be associated with immune-mediated side effects in other organs. Among the more common ones is gastrointestinal tract involvement, especially colitis. In most patients, colitis is mild or responds to corticosteroid treatment. A smaller proportion of patients, more often those treated with cytotoxic T lymphocyte antigen-4 inhibitors, may have a more severe course of colitis, even life-threatening complications. In these patients, prompt action, timely diagnosis with endoscopic evaluation and early treatment with high-dose corticosteroids and, if ineffective, rescue therapy with biologic agents such as infliximab and vedolizumab are needed. We present three cases from our clinical practice, data on incidence and clinical presentation, current recommendations regarding diagnostic approach and treatment of immune checkpoint inhibitors induced colitis.

Immune Checkpoint Inhibitor-induced Pancreatitis with Pancreatic Enlargement Mimicking Autoimmune Pancreatitis: A Case Report and Review of the Literature

A 61-year-old woman was administered 35 cycles of pembrolizumab for the treatment of recurrent endometrial cancer, achieving a complete response. She presented with asymptomatic pancreatic enlargement and elevated hepatobiliary enzymes, but amylase and lipase levels were within the normal ranges. Intrapancreatic bile duct stenosis due to pancreatic enlargement was present, mimicking autoimmune pancreatitis on computed tomography performed before the onset of clinical manifestations. A histological examination of a biopsy specimen showed lymphocyte and plasma cell infiltration with dense fibrosis in the stroma. The patient was successfully treated with oral prednisolone. There were no manifestations of recurrent pancreatitis after tapering the prednisolone dose.