ArticlePancreas
Asymptomatic Lipase Elevation After Immune Checkpoint Inhibitors Reflects Pancreatic Injury With Volume Loss but Minimal Clinical Sequelae.
Article in Pancreas. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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3 authors.
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Abstract
objectivesAsymptomatic lipase elevation (ALE) after immune checkpoint inhibitor therapy (ICI-℞) is considered a laboratory abnormality distinct from clinical pancreatitis. We hypothesized that ALE indicates pancreatic injury defined as imaging evidence of pancreatitis on CT/PET scans and/or volume loss on CT pancreatic volumetry (PV). We examined the safety of continued ICI-℞ in ALE.
methodsWe identified 1146 ICI-treated patients with PET/CT and lipase measurement within 1 month. Asymptomatic patients (n=1123) were stratified by lipase levels: normal (n=837), 1-3× (n=222), or ≥3× (n=64) upper limit of normal (ULN). We compared pancreas volume (baseline vs. 1 year and % with ≥20% volume loss) in 98 patients across these strata. Clinical sequelae (pancreatitis, endocrine/exocrine insufficiency) were recorded for patients continuing ICI-℞.
resultsNormal lipase cohort showed no evidence of pancreatic injury. In ALE with lipase 1-3×ULN, CT/PET rarely showed pancreatitis (0.5%/2%); ≥20% volume loss occurred in 28%. In ALE with lipase ≥3×ULN, CT+/PET+/≥20% volume loss was seen in 9%/16%/57%, respectively ( P <0.0001 for each feature vs. 1-3x ULN). Pancreas volume (median) decreased significantly in lipase ≥3× ( P <0.0001). Continuing ICI-℞ in patients with ALE (n=33) and symptomatic pancreatitis (n=5) resulted in minimal to no clinical sequelae.
conclusionsALE after ICI-℞ indicates pancreatic injury characterized best by volume loss. Despite this, therapy continuation is well tolerated with minimal clinical sequelae. Although our data do not change current management, they do suggest that ALE and ICI-P represent a clinical spectrum of a shared pathophysiology.
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