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irAE Pancreatitis — SCE Medical Oncology MCQ

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ModerateImmunotherapy & Targeted TherapyirAE PancreatitisSCE Medical Oncology

A 63-year-old man with advanced melanoma on nivolumab develops elevated lipase (5× ULN) but is completely asymptomatic. CT abdomen is normal. What is the most appropriate management?

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Correct answer: C — Continue nivolumab with monitoring — asymptomatic lipase elevation does not necessarily indicate clinical pancreatitis

Asymptomatic lipase/amylase elevation occurs in approximately 10-15% of ICI-treated patients and does not always represent clinical pancreatitis. In the absence of symptoms (abdominal pain, nausea/vomiting), radiological evidence of pancreatic inflammation, or other organ dysfunction, ICI can be continued with close monitoring. Grade 3-4 amylase/lipase elevation with symptoms warrants ICI hold and corticosteroid treatment. This contrasts with hepatic transaminase elevation where treatment decisions are more directly linked to enzyme levels.

Reference: ESMO 2024 irAE Management Guidelines; de Filette et al J Immunother Cancer 2019