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<p>Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy but are associated with immune-related adverse events (irAEs) affecting multiple organ systems. ICI-related pancreatitis (ICI-P) is an uncommon but clinically significant toxicity with potential for irreversible pancreatic damage. This review synthesizes current evidence on the epidemiology, pathophysiology, diagnosis, and management of ICI-P. The incidence ranges from 0.5% to 5.7% depending on definitions and regimens, with combination immunotherapy conferring a significantly higher risk. Histopathologically, ICI-P is characterized by acinar-centric T cell infiltration with temporal evolution from CD4 + to CD8 + predominance. Most cases present as asymptomatic lipase elevation rather than clinical pancreatitis; however, long-term sequelae, including pancreatic atrophy (44–55%), new-onset diabetes mellitus, and exocrine insufficiency, are increasingly recognized. The role of corticosteroids remains controversial, with evidence suggesting efficacy for acute symptoms but uncertain impact on long-term outcomes. Notably, ICI-P development may be associated with improved overall survival, potentially reflecting enhanced antitumor immunity. This review provides an evidence-based framework for diagnosis and management while highlighting unresolved controversies requiring further investigation.</p>

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Immune checkpoint inhibitor-related pancreatitis: a comprehensive review of epidemiology, pathophysiology, and management

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月1日

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  • Yoonchan Lee,
  • Dongwook Oh,
  • Sung Hyun Cho,
  • Seung-Mo Hong,
  • Tae Jun Song

摘要

Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy but are associated with immune-related adverse events (irAEs) affecting multiple organ systems. ICI-related pancreatitis (ICI-P) is an uncommon but clinically significant toxicity with potential for irreversible pancreatic damage. This review synthesizes current evidence on the epidemiology, pathophysiology, diagnosis, and management of ICI-P. The incidence ranges from 0.5% to 5.7% depending on definitions and regimens, with combination immunotherapy conferring a significantly higher risk. Histopathologically, ICI-P is characterized by acinar-centric T cell infiltration with temporal evolution from CD4 + to CD8 + predominance. Most cases present as asymptomatic lipase elevation rather than clinical pancreatitis; however, long-term sequelae, including pancreatic atrophy (44–55%), new-onset diabetes mellitus, and exocrine insufficiency, are increasingly recognized. The role of corticosteroids remains controversial, with evidence suggesting efficacy for acute symptoms but uncertain impact on long-term outcomes. Notably, ICI-P development may be associated with improved overall survival, potentially reflecting enhanced antitumor immunity. This review provides an evidence-based framework for diagnosis and management while highlighting unresolved controversies requiring further investigation.