Brown University / Rhode Island Hospital Providence, RI
Sapana Gupta, MD1, Casey Reed, MD2, Sathwik Madireddy, MD1, MacKenzie Adams, MD1, Charmi Trivedi, MD1, Jacqueline J. Chu, MD, MS1, Curtis Petruzzelli, MD1, Kanika Malani, MD3, William Park, MD1, Rebecca Steuer, MD1, Maria Constantinou, MD1, Galina Lagos, MD1, Megan Begnoche, RN1, Sandeep Jain, MD1, May Min, MD1, Matthew Hadfield, MD1 1Brown University / Rhode Island Hospital, Providence, RI; 2Brown University, Providence, RI; 3Yale New Haven Hospital, New Haven, CT Introduction: Immune checkpoint inhibitors (ICIs) have become the standard of care across a multitude of malignancies. Immune-related adverse events (irAEs) result from off-target inflammation from autoreactive T-cells. Inflammation of the pancreas is a rare irAE with the potential to have significant morbidity. The National Comprehensive Cancer Network (NCCN) provides guidelines for the assessment/grading of asymptomatic pancreatic enzyme elevation and acute pancreatitis. However, the diagnostic criteria for pancreatic irAEs remain poorly defined due to the paucity of cases.
Case Description/
Methods: Records from a tertiary care center were manually reviewed to identify patients who received ICIs between 2015 and 2024. Of 2,723 patients on ICIs, 9 patients presented with suspected pancreatic irAE. The median age was 68 years old. Malignancies included melanoma (n=5), renal cell carcinoma (n=2), lung adenocarcinoma (n=1), and urothelial carcinoma (n=1). Immune checkpoint inhibitor regimens included nivolumab/ipilimumab (n=3), pembrolizumab monotherapy (n=4), and nivolumab monotherapy (n=2). Seven patients had additional irAEs reported, most commonly colitis (n=4), dermatitis (n=2), and mucositis (n=2). The median time from ICI initiation to pancreatic irAE diagnosis was 210 days, with a median of 10 ICI cycles administered. Five patients were admitted to the hospital for evaluation. Active alcohol use was reported in 5 cases. Four patients were asymptomatic; five had abdominal symptoms. Four patients did not have triglyceride levels tested and eight did not have IgG4 levels tested at the time of diagnosis. In addition, 3 patients had negative CT readings, but two of these had positron emission tomography (PET) scans suggestive of pancreatitis. Overall, only two patients received GI consultation, one inpatient and the other outpatient. Discussion: This case series underscores the diagnostic challenges of pancreatic immune-related adverse events (irAEs) in patients receiving ICIs. Despite existing guidelines, gaps in practice—such as omitted triglyceride and IgG4 testing, limited imaging, and infrequent GI consultation—highlight the need for more consistent evaluation. Improved use of CT imaging, early multidisciplinary input, and standardized diagnostic pathways could enhance care. Strengthening the diagnostic approach is essential for timely management and for informing future prospective studies on this rare toxicity.
Figure: Table 1: Baseline Characteristics at Pancreatic irAE Diagnosis
Figure: Table 2: Initial Diagnostic Workup and Consultation for Pancreatic irAE
Disclosures: Sapana Gupta indicated no relevant financial relationships. Casey Reed indicated no relevant financial relationships. Sathwik Madireddy indicated no relevant financial relationships. MacKenzie Adams indicated no relevant financial relationships. Charmi Trivedi indicated no relevant financial relationships. Jacqueline Chu indicated no relevant financial relationships. Curtis Petruzzelli indicated no relevant financial relationships. Kanika Malani indicated no relevant financial relationships. William Park indicated no relevant financial relationships. Rebecca Steuer indicated no relevant financial relationships. Maria Constantinou indicated no relevant financial relationships. Galina Lagos indicated no relevant financial relationships. Megan Begnoche indicated no relevant financial relationships. Sandeep Jain indicated no relevant financial relationships. May Min indicated no relevant financial relationships. Matthew Hadfield indicated no relevant financial relationships.
Sapana Gupta, MD1, Casey Reed, MD2, Sathwik Madireddy, MD1, MacKenzie Adams, MD1, Charmi Trivedi, MD1, Jacqueline J. Chu, MD, MS1, Curtis Petruzzelli, MD1, Kanika Malani, MD3, William Park, MD1, Rebecca Steuer, MD1, Maria Constantinou, MD1, Galina Lagos, MD1, Megan Begnoche, RN1, Sandeep Jain, MD1, May Min, MD1, Matthew Hadfield, MD1. P2294 - Diagnostic Workup for Pancreatic Immune-Related Adverse Events: A Case Series from a Tertiary Care Center, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
