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irAE Pancreatitis Symptomatic vs Asymptomatic — SCE Medical Oncology MCQ

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HardImmunotherapy & Targeted TherapyirAE Pancreatitis Symptomatic vs AsymptomaticSCE Medical Oncology

A patient receiving checkpoint treatment has moderate epigastric pain, lipase 12 times the upper limit of normal and CT-confirmed acute pancreatitis without gallstones, alcohol exposure or biliary obstruction. What is the best initial immune-toxicity plan?

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Correct answer: D — Hold checkpoint treatment, give supportive care and add corticosteroid if recovery stalls

This is symptomatic, imaging-confirmed pancreatitis rather than an isolated enzyme rise, so checkpoint treatment should be held and standard supportive care started. SITC guidance allows corticosteroid consideration if symptoms do not improve after three to five days. Continuing treatment applies only to asymptomatic enzyme elevation under close monitoring. Infliximab is not first-line pancreatitis therapy. Lipase magnitude alone does not mandate permanent discontinuation or immediate high-dose steroid. ERCP is not indicated when imaging and laboratory assessment do not support biliary obstruction.

Reference: SITC clinical practice guideline on immune-checkpoint-inhibitor adverse events (Published June 2021): https://pmc.ncbi.nlm.nih.gov/articles/PMC8237720/; West of Scotland Cancer Network immune-related adverse-events guideline (Version 4.0, March 2024; review due March 2027): https://rightdecisions.scot.nhs.uk/media/b11eeh40/woscan-immunotherapy-iraes-guideline-v40.pdf