SHM Converge Scientific Abstract ePoster Gallery-Pembrolizumab Induced Pancreatitis in a Patient With Metastatic Melanoma: A Case Report

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This case report describes pembrolizumab-induced pancreatitis in a 96-year-old man with recurrent metastatic melanoma of the scalp. Immune checkpoint inhibitors (ICIs) are important cancer therapies but can cause immune-related adverse events, including rare pancreatic toxicity.<br /><br />The patient developed acute epigastric pain radiating to the back, with nausea and anorexia, shortly after starting pembrolizumab. His first pancreatitis episode occurred two weeks after treatment began. Initial laboratory tests and imaging did not reveal another clear cause, such as gallstones, autoimmune pancreatitis, or pseudocyst. Because an immune-related adverse event was suspected, pembrolizumab was temporarily stopped. After about four weeks without symptoms, it was restarted.<br /><br />Following four cycles, he experienced a second episode of pancreatitis, leading to another interruption of immunotherapy. A third episode occurred even after pembrolizumab had been discontinued for two months. During this episode, lipase was elevated into the 800s, and CT imaging again showed no pseudocyst. He improved with conservative treatment, including bowel rest, intravenous fluids, and pain control, and he was able to resume diet without recurrence of pain. His oncologist then permanently discontinued pembrolizumab because of recurrent pancreatitis.<br /><br />The authors note that ICI-related pancreatitis is uncommon, reported in less than 1% of cases, and is more often associated with combination immunotherapy, though this case shows that pembrolizumab alone can also cause it. Standard management often includes stopping the offending drug and using corticosteroids, but this patient improved without steroids, supporting evidence that supportive care may be sufficient in some cases.<br /><br />This report highlights the need for vigilance for pancreatic toxicity with ICIs, especially in older patients, and emphasizes that even single-agent pembrolizumab can trigger recurrent pancreatitis.

Asset Subtitle

Alba L. Caceres Munoz

Meta Tag

Author List Alba L. Caceres Munoz, Anunaya Aashish, Cayo Azevedo Silva, Kishan Talagadadeevi

Category Clinical Vignettes

Concept Immune Checkpoint Inhibitor

Concept Pancreatitis

Concept Pembrolizumab

Concept Adverse Event

Concept Toxicity

Distinguished Non-Finalist

Presenter Organization Texas Health Resources HEB/ Denton

Presenting Author Alba L. Caceres Munoz

Track Adult

Keywords

pembrolizumab

pancreatitis

immune checkpoint inhibitors

melanoma

immune-related adverse events

pancreatic toxicity

recurrent pancreatitis

lipase elevation

conservative treatment

older patient

Immune Checkpoint Inhibitor

Pancreatitis

Pembrolizumab

Adverse Event

Toxicity