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Immune Checkpoint Inhibitor-Induced Pancreatic Injury: Imaging Findings and Literature Review

Abstract

The immunotherapy revolution in cancer treatment involves a variety of specialists, not only oncologists, but also internal medicine physicians, endocrinologists, dermatologists, gastroenterologists, rheumatologists, and radiologists, introducing new scenarios and novel challenges in the diagnosis and management of a number of novel immune-related adverse events. Among these, immune checkpoint inhibitor-induced pancreatic injury has been described (occurring in up to 4% of patients) and has been reported to be responsible for visits to the emergency departments in up to 1.9% of patients treated with immune checkpoint inhibitors. This side effect can be symptomatic or non-symptomatic, and can be associated with the development of long-term damage to the pancreas, requiring the involvement of different specialists, including radiologists and gastroenterologists in the multidisciplinary team that manages these patients. The aim of this narrative review is to provide a summary of the available literature related to immune checkpoint inhibitor-induced pancreatic injury including the epidemiology, the clinical findings, and the management algorithm for diagnosis with a detailed analysis of the differential diagnosis at imaging, and treatment. A more in-depth focus is dedicated to symptomatic acute pancreatitis with its peculiar findings at imaging (ultrasound, computed tomography, and magnetic resonance imaging).

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Correspondence to Michele Porcu.

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This research did not receive a specific grant from funding agency in the public, commercial, or non-profit sectors.

Conflict of interest

Alfredo Addeo has received research funding from Boehringer Ingelheim. He has played a consulting or advisory role in relationship with MSD, Bristol-Myers Squibb, Roche, Pfizer, Takaeda AstraZeneca and Boehringer Ingelheim. Michele Porcu, Cinzia Solinas, Cristina Migali, Angelo Battaglia, Marina Schena, Karen Willard-Gallo and Luca Saba declare that they have no conflicts of interest that might be relevant to the contents of this manuscript.

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All patients whose imaging pictures are present in this manuscript gave their consent for the publication.

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Cristina Migali: the opinions expressed in this article are the personal views of the author and may not be understood or quoted as being made on behalf of or reflecting the position of the Italian Medicines Agency (AIFA).

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Porcu, M., Solinas, C., Migali, C. et al. Immune Checkpoint Inhibitor-Induced Pancreatic Injury: Imaging Findings and Literature Review. Targ Oncol (2020) doi:10.1007/s11523-019-00694-w

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