Clinical Significance of Pancreatic Atrophy Induced by Immune-Checkpoint Inhibitors: A Case-Control Study

Immune-checkpoint inhibitor (ICI)-related diarrhea is attributed to inflammatory colitis, with no other drug-related differential diagnosis. Here, we investigated the occurrence of pancreatic atrophy (PA) in ICI-treated cancer patients and its correlation to exocrine pancreatic insufficiency (EPI)....

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Published in:Cancer immunology research 2018-12, Vol.6 (12), p.1453-1458
Main Authors: Eshet, Yael, Baruch, Erez Nissim, Shapira-Frommer, Ronnie, Steinberg-Silman, Yael, Kuznetsov, Teodor, Ben-Betzalel, Guy, Daher, Sameh, Gluck, Iris, Asher, Nethanel, Apter, Sara, Schachter, Jacob, Bar, Jair, Boursi, Ben, Markel, Gal
Format: Article
Language:English
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Summary:Immune-checkpoint inhibitor (ICI)-related diarrhea is attributed to inflammatory colitis, with no other drug-related differential diagnosis. Here, we investigated the occurrence of pancreatic atrophy (PA) in ICI-treated cancer patients and its correlation to exocrine pancreatic insufficiency (EPI). Metastatic melanoma, non-small cell lung carcinoma, and head and neck squamous cell carcinoma patients ( = 403) treated with anti-PD-1 ( = 356) or anti-CTLA-4 ( = 47) were divided into a case group (radiologic evidence of PA); control group matched by age, gender, and previous lines of treatment; and colitis group (ICI-induced colitis). Quantitative pancreatic volumetry was used for calculation of the decrease in pancreatic volume over time (atrophy rate). Thirty-one patients (7.7%) developed PA compared with 41 matched controls ( = 0.006). Four patients developed EPI, all from the anti-PD-1-treated group, which resolved with oral enzyme supplementation. The atrophy rate did not correlate with EPI ( = 0.87). EPI-related diarrhea presented at a median of 9 months, whereas the diarrhea of anti-PD-1-induced colitis patients ( = 22) was presented at a median of 2 months ( = 0.029). ICI-induced PA is irreversible and can result in EPI. EPI should be suspected in cases of late-onset steroid-resistant diarrhea with features of steatorrhea and treated with oral enzyme supplements.
ISSN:2326-6066
2326-6074
DOI:10.1158/2326-6066.cir-17-0659