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Immune-related pancreatitis associated with checkpoint blockade in melanoma

Kohlmann, Johannes; Wagenknecht, Daniel; Simon, Jan-Christoph; Ziemer, Mirjana

doi: 10.1097/CMR.0000000000000611
Short Communications: Clinical Research
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Recognizing and treating rare checkpoint inhibitor related adverse events may be a clinical challenge in melanoma therapy. One of rather rare affected organs is the pancreas. Immune-related pancreatitis is difficult to recognize due to its variable clinical characteristics. Asymptomatic elevations of serum lipase and/or amylase during therapy with immune-checkpoint blockade impede the diagnostic process. We present a patient who developed an immune-related pancreatitis within the first 4 months of immunotherapy. Treatment with high dose systemic glucocorticosteroids with very slow tapering over a total period of 6.5 months was necessary to keep the patient symptom free as well as to maintain long-term normalization of serum lipase. Checkpoint blockade related pancreatitis may occur as acute or chronic disease and may lack any radiographic signs. As in our case, very slow tapering of initially high dose systemic glucocorticosteroids seems to be a crucial requirement for lasting recovery. Even after successful treatment, late-onset secondary pancreatic insufficiency may occur and patients have to be followed up at regular intervals. Restarting immunotherapy after resolution of immune-related pancreatitis is possible but needs careful risk-benefit consideration.

Department of Dermatology, University of Leipzig Medical Center, Leipzig, Germany

Received 13 February 2019 Accepted 15 March 2019

Correspondence to Johannes Kohlmann, Department of Dermatology, University of Leipzig Medical Center, Philipp-Rosenthal-Str.23, 04103 Leipzig, Germany Tel: + 49 341 971 8360; fax: + 49 341 971 8609; e-mail: johannes.kohlmann@medizin.uni-leipzig.de

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