Isolated immune-related pancreatic exocrine insufficiency associated with pembrolizumab therapy

被引：19

作者：

Prasanna, Thiru ^{[1
,2
]}

McNeil, Catriona M. ^{[1
,2
,3
]}

Nielsen, Theresa ^{[2
]}

Parkin, David ^{[4
]}

机构：

[1] Chris OBrien Lifehouse, Dept Med Oncol, Camperdown, NSW, Australia

[2] Royal Prince Alfred Hosp, Camperdown, NSW, Australia

[3] Univ Sydney, Sydney Med Sch, Sydney, NSW, Australia

[4] Wyong Publ Hosp, Dept Gastroenterol, Hamlyn Terrace, NSW, Australia

来源：

IMMUNOTHERAPY | 2018年 / 10卷 / 03期

关键词：

checkpoint inhibitors; exocrine glands; immune-related colitis; immunotherapy; pancreatic enzymes; pembrolizumab; CELL-CARCINOMA; REPLACEMENT THERAPY; OPEN-LABEL; MULTICENTER; DIAGNOSIS; ANTI-PD-1; TRIAL;

D O I：

10.2217/imt-2017-0126

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

We report a case of isolated immune-related pancreatic exocrine insufficiency in a patient treated with pembrolizumab for metastatic melanoma. This patient presented with explosive diarrhea and was treated with high dose corticosteroids for possible immune-related colitis. However, biopsies from colon and duodenum did not show any histological evidence of colitis/enteritis. Serum amylase and lipase were not elevated. There was no evidence of pancreatitis or pancreatic metastases on imaging. Significantly lower fecal elastase test on two occasions confirmed the diagnosis of pancreatic exocrine insufficiency. He was treated with pancreatic enzyme supplementation with complete resolution of diarrhea. This case reinforces the importance of awareness and anticipation of unusual immune-related adverse events related to checkpoint inhibitors.

引用

页码：171 / 175

页数：5

共 16 条

[1] Adverse Events Associated with Immune Checkpoint Blockade in Patients with Cancer: A Systematic Review of Case Reports [J].

Abdel-Wahab, Noha ;

Shah, Mohsin ;

Suarez-Almazor, Maria E. .

PLOS ONE, 2016, 11 (07)

[2] An Endoscopic Pancreatic Function Test With Cholecystokinin-Octapeptide for the Diagnosis of Chronic Pancreatitis [J].

Conwell, Darwin L. ;

Zuccaro, Gregory, Jr. ;

Vargo, John J. ;

Morrow, J. Brad ;

Obuchowski, Nancy ;

Dumot, John A. ;

Trolli, Patricia A. ;

Burton, Allison ;

O'Laughlin, Cathy ;

Van Lente, Frederick .

CLINICAL GASTROENTEROLOGY AND HEPATOLOGY, 2003, 1 (03) :189-194

[3] LONGITUDINAL EVALUATION OF SERUM TRYPSINOGEN MEASUREMENT IN PANCREATIC-INSUFFICIENT AND PANCREATIC-SUFFICIENT PATIENTS WITH CYSTIC-FIBROSIS [J].

COUPER, RTL ;

COREY, M ;

DURIE, PR ;

FORSTNER, GG ;

MOORE, DJ .

JOURNAL OF PEDIATRICS, 1995, 127 (03) :408-413

[4] Enzyme replacement therapy for pancreatic insufficiency: present and future [J].

Fieker, Aaron ;

Philpott, Jessica ;

Armand, Martine .

CLINICAL AND EXPERIMENTAL GASTROENTEROLOGY, 2011, 4 :55-73

[5] A population-based study of the biochemical and clinical expression of the H63D hemochromatosis mutation [J].

Gochee, PA ;

Powell, LW ;

Cullen, DJ ;

Du Sart, D ;

Rossi, E ;

Olynyk, JK .

GASTROENTEROLOGY, 2002, 122 (03) :646-651

[6] Pancreatic Exocrine Insufficiency: Diagnostic Evaluation and Replacement Therapy with Pancreatic Enzymes [J].

Hammer, Heinz F. .

DIGESTIVE DISEASES, 2010, 28 (02) :339-343

[7] Atrophic exocrine pancreatic insufficiency associated with anti-PD1 therapy [J].

Hoadley, A. ;

Sandanayake, N. ;

Long, G. V. .

ANNALS OF ONCOLOGY, 2017, 28 (02) :434-435

[8] Cutaneous, gastrointestinal, hepatic, endocrine, and renal side-effects of anti-PD-1 therapy [J].

Hofmann, Lars ;

Forschner, Andrea ;

Loquai, Carmen ;

Goldinger, Simone M. ;

Zimmer, Lisa ;

Ugurel, Selma ;

Schmidgen, Maria I. ;

Gutzmer, Ralf ;

Utikal, Jochen S. ;

Goeppner, Daniela ;

Hassel, Jessica C. ;

Meier, Friedegund ;

Tietze, Julia K. ;

Thomas, Ioannis ;

Weishaupt, Carsten ;

Leverkus, Martin ;

Wahl, Renate ;

Dietrich, Ursula ;

Garbe, Claus ;

Kirchberger, Michael C. ;

Eigentler, Thomas ;

Berking, Carola ;

Gesierich, Anja ;

Krackhardt, Angela M. ;

Schadendorf, Dirk ;

Schuler, Gerold ;

Dummer, Reinhard ;

Heinzerling, Lucie M. .

EUROPEAN JOURNAL OF CANCER, 2016, 60 :190-209

[9] Avelumab in patients with chemotherapy-refractory metastatic Merkel cell carcinoma: a multicentre, single-group, open-label, phase 2 trial [J].

Kaufman, Howard L. ;

Russell, Jeffery ;

Hamid, Omid ;

Bhatia, Shailender ;

Terheyden, Patrick ;

D'Angelo, Sandra P. ;

Shih, Kent C. ;

Lebbe, Celeste ;

Linette, Gerald P. ;

Milella, Michele ;

Brownell, Isaac ;

Lewis, Karl D. ;

Lorch, Jochen H. ;

Chin, Kevin ;

Mahnke, Lisa ;

von Heydebreck, Anja ;

Cuillerot, Jean-Marie ;

Nghiem, Paul .

LANCET ONCOLOGY, 2016, 17 (10) :1374-1385

[10] Faecal elastase 1 A novel, highly sensitive, and specific tubeless pancreatic function test [J].

Loser, C ;

Mollgaard, A ;

Folsch, UR .

GUT, 1996, 39 (04) :580-586

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