Nivolumab-induced Pancreatitis: An Immune-related Adverse Event
Abstract
A 72-year-old man treated with nivolumab for widely metastatic squamous cell carcinoma of the lung (pleural, bone, and brain metastases) presented to the hospital for follow-up fluorine 18 fluoro-2-deoxy-d-glucose (FDG) PET/CT. This examination showed a diffusely enlarged pancreas with a markedly elevated standardized uptake value of 7.1 (Figs 1, 2). The patient was asymptomatic; however, laboratory evaluation revealed elevated amylase, lipase, elastase, and C-reactive protein levels. This finding was consistent with the diagnosis of pancreatitis related to an immune-related adverse event from nivolumab therapy. As the patient had an ongoing infection of the left iliopsoas bursa, no steroids were prescribed for this complication. After 2 months, a repeat FDG PET/CT examination showed resolution of the pancreatic uptake.
Figure 1: Coronal maximum intensity projection fluorine 18 fluoro-2-deoxy-d-glucose (FDG) PET scan in 72-year-old man being treated with nivolumab for metastatic squamous cell carcinoma (primary lung cancer) shows increased uptake in the pancreas (arrowheads), which is diagnostic for pancreatitis from an immune-related adverse event. Other sites of metastatic disease (mediastinal lymph nodes, both lungs, and left iliopsoas muscle abscess) also show increased FDG uptake.
Figure 2: Axial reference CT scan (attenuation correction scan) from the same PET/CT examination as in Figure 1 shows an enlarged pancreas with inflammation in anterior pararenal space (arrows), which is consistent with pancreatitis.
Pancreatitis is a rare immune-related adverse event from nivolumab (immune checkpoint inhibitor) therapy (1). The imaging features are similar to those found in autoimmune pancreatitis (2). Steroids (glucocorticoids) are often used to treat immune-related adverse events. However, as in this case, simple cessation of nivolumab therapy allowed the immune-related pancreatitis to resolve on its own.
Disclosures of Conflicts of Interest: H.S. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: received honorarium from Taiho Pharmaceutical for lecture fee. Other relationships: disclosed no relevant relationships. K.O. disclosed no relevant relationships.References
- 1. Frequency and imaging features of abdominal immune-related adverse events in metastatic lung cancer patients treated with PD-1 inhibitor. Abdom Radiol (NY) 2019;44(5):1917–1927. Crossref, Medline, Google Scholar
- 2. . Nivolumab-related pancreatitis with autoimmune pancreatitis-like imaging features. J Gastroenterol Hepatol 2019;34(8):1274. Crossref, Medline, Google Scholar
Article History
Received: July 18 2019Revision requested: Aug 14 2019
Revision received: Aug 19 2019
Accepted: Aug 29 2019
Published online: Oct 15 2019
Published in print: Dec 2019
