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irAE Pancreatitis — SCE Medical Oncology MCQ

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ModerateImmunotherapy & Targeted TherapyirAE PancreatitisSCE Medical Oncology

A 65-year-old woman develops new abdominal pain and CT confirms acute pancreatitis while on nivolumab + ipilimumab for melanoma. Lipase is 10× ULN. She has no gallstones and minimal alcohol intake. What is the management?

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Correct answer: D — Hold both agents, start IV methylprednisolone 1-2 mg/kg/day, supportive care

Immune-related pancreatitis is a recognised irAE (approximately 1-3% with combination ICI). For symptomatic pancreatitis with lipase >3× ULN (grade 2-3), both ICIs should be held and corticosteroids started (prednisolone 0.5-1 mg/kg for grade 2; methylprednisolone 1-2 mg/kg for grade 3). Supportive care (NPO, IV fluids, analgesia) follows standard acute pancreatitis management. Imaging to exclude biliary obstruction and other causes is important. Infliximab may be considered for steroid-refractory cases.

Reference: ESMO 2024 irAE Management Guidelines; ASCO irAE Guidelines 2021