Exocrine pancreatic insufficiency secondary to checkpoint inhibitors. A clinical case report

Abstract

Modern immunotherapy has been a flood of hope for both, patients diagnosed with cancer and for oncologists, but this has forced health professionals, within their different disciplines, to internalize and educate themselves regarding new diagnostic challenges of immunological-related adverse events (irEA), difficult to address and even more so to treat in direct proportion to their frequency of appearance. Although gastrointestinal toxicity due to immunological checkpoint inhibitors (ICI) is well known, its leading role is at the expense of enterocolitis and hepatitis, among others, relegating less than 1% to cases such as pancreatitis, where morphological and histopathological alterations , both of the ducts and of the pancreatic parenchyma, can compromise endocrine and/or exocrine function. The latter, reported in the literature only in a few cases, has a complex and difficult diagnostic approach with a flowery and disabling symptomatic sign picture, which motivates the present bibliographic review. The case of a female patient diagnosed with metastatic melanoma under treatment with nivolumab with development of exocrine pancreatic insufficiency (EPI) 7 months after suspending immunotherapy is discussed below.