Exocrine Pancreatic Insufficiency Induced by Immune Checkpoint Inhibitors.
checkpoint inhibitor
clinical pancreatitis
diabetes
exocrine pancreatic insufficiency
Journal
The oncologist
ISSN: 1549-490X
Titre abrégé: Oncologist
Pays: England
ID NLM: 9607837
Informations de publication
Date de publication:
11 Dec 2023
11 Dec 2023
Historique:
received:
27
11
2022
accepted:
25
04
2023
pubmed:
7
6
2023
medline:
7
6
2023
entrez:
7
6
2023
Statut:
ppublish
Résumé
Scant data describe exocrine pancreatic insufficiency (EPI) secondary to immune checkpoint inhibitor (ICI) use. The goal of this study is to describe the incidence, risk factors, and clinical characteristics of patients with ICI-related EPI. A single center, retrospective case-control study was performed of all ICI-treated patients at Memorial Sloan Kettering Cancer Center between January 2011 and July 2020. ICI-related EPI patients had steatorrhea with or without abdominal discomfort or weight loss, started pancrelipase after initiation of ICI, and demonstrated symptomatic improvement with pancrelipase. Controls were matched 2:1 by age, race, sex, cancer type, and year of ICI start. Of 12 905 ICI-treated patients, 23 patients developed ICI-related EPI and were matched to 46 controls. The incidence rate of EPI was 1.18 cases per 1000 person-years and the median onset of EPI was 390 days after the first dose of ICI. All 23 (100%) EPI cases had steatorrhea that improved with pancrelipase, 12 (52.2%) had weight loss, and 9 (39.1%) had abdominal discomfort; none had changes of chronic pancreatitis on imaging. Nine (39%) EPI patients had episodes of clinical acute pancreatitis preceding the onset of EPI, compared to 1 (2%) control (OR 18.0 (2.5-789.0), P < .001). Finally, the EPI group exhibited higher proportions of new or worsening hyperglycemia after ICI exposure compared with the control group (9 (39.1%) vs. 3 (6.5%), P < .01). ICI-related EPI is a rare but clinically significant event that should be considered in patients with late onset diarrhea after ICI treatment and often is associated with development of hyperglycemia and diabetes.
Sections du résumé
BACKGROUND
BACKGROUND
Scant data describe exocrine pancreatic insufficiency (EPI) secondary to immune checkpoint inhibitor (ICI) use. The goal of this study is to describe the incidence, risk factors, and clinical characteristics of patients with ICI-related EPI.
PATIENTS AND METHODS
METHODS
A single center, retrospective case-control study was performed of all ICI-treated patients at Memorial Sloan Kettering Cancer Center between January 2011 and July 2020. ICI-related EPI patients had steatorrhea with or without abdominal discomfort or weight loss, started pancrelipase after initiation of ICI, and demonstrated symptomatic improvement with pancrelipase. Controls were matched 2:1 by age, race, sex, cancer type, and year of ICI start.
RESULTS
RESULTS
Of 12 905 ICI-treated patients, 23 patients developed ICI-related EPI and were matched to 46 controls. The incidence rate of EPI was 1.18 cases per 1000 person-years and the median onset of EPI was 390 days after the first dose of ICI. All 23 (100%) EPI cases had steatorrhea that improved with pancrelipase, 12 (52.2%) had weight loss, and 9 (39.1%) had abdominal discomfort; none had changes of chronic pancreatitis on imaging. Nine (39%) EPI patients had episodes of clinical acute pancreatitis preceding the onset of EPI, compared to 1 (2%) control (OR 18.0 (2.5-789.0), P < .001). Finally, the EPI group exhibited higher proportions of new or worsening hyperglycemia after ICI exposure compared with the control group (9 (39.1%) vs. 3 (6.5%), P < .01).
CONCLUSION
CONCLUSIONS
ICI-related EPI is a rare but clinically significant event that should be considered in patients with late onset diarrhea after ICI treatment and often is associated with development of hyperglycemia and diabetes.
Identifiants
pubmed: 37285223
pii: 7191692
doi: 10.1093/oncolo/oyad150
pmc: PMC10712706
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1085-1093Subventions
Organisme : NCI NIH HHS
ID : P30 CA008748
Pays : United States
Informations de copyright
© The Author(s) 2023. Published by Oxford University Press.
Références
Ann Oncol. 2017 Feb 1;28(2):434-435
pubmed: 27864215
Eur J Radiol. 2020 Oct;131:109250
pubmed: 32905952
BMJ Open Diabetes Res Care. 2019 Feb 13;7(1):e000591
pubmed: 30899528
Eur J Cancer. 2017 Dec;87:216-218
pubmed: 28993041
J Immunother Cancer. 2019 Feb 6;7(1):31
pubmed: 30728076
Pancreatology. 2019 Jun;19(4):587-594
pubmed: 31076344
Front Oncol. 2021 Feb 25;11:627612
pubmed: 33732647
Front Endocrinol (Lausanne). 2021 Apr 13;12:620522
pubmed: 33927691
Diabetes. 2018 Aug;67(8):1471-1480
pubmed: 29937434
Cancer Immunol Res. 2018 Dec;6(12):1453-1458
pubmed: 30275274
Diabetes Care. 2018 Dec;41(12):e150-e151
pubmed: 30305348
Br J Cancer. 2020 Jul;123(2):207-215
pubmed: 32418993
JAMA Oncol. 2018 Feb 01;4(2):173-182
pubmed: 28973656
Eur J Cancer. 2021 May;149:1-10
pubmed: 33812141
Immunotherapy. 2018 Mar;10(3):171-175
pubmed: 29370723
PLoS Med. 2007 Oct 16;4(10):e297
pubmed: 17941715