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Symptomatic ICI Pancreatitis — SCE Medical Oncology MCQ

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ModerateMelanoma & SkinSymptomatic ICI PancreatitisSCE Medical Oncology

A 62-year-old man with advanced melanoma on nivolumab develops new abdominal pain. Lipase is 15× ULN. CT shows pancreatic tail swelling without peripancreatic collections. He has significant epigastric pain. What is the management?

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Correct answer: C — Hold nivolumab, start prednisolone 0.5-1 mg/kg (SYMPTOMATIC pancreatitis with imaging changes), supportive care (NPO, IV fluids, analgesia); this differs from ASYMPTOMATIC isolated lipase elevation where ICI can be continued

This patient has SYMPTOMATIC ICI-induced pancreatitis (abdominal pain + elevated lipase + CT changes). This requires: ICI hold, corticosteroids (prednisolone 0.5-1 mg/kg for grade 2; methylprednisolone 1-2 mg/kg for grade 3), and standard pancreatitis supportive care. This is fundamentally different from ASYMPTOMATIC isolated lipase elevation (which does NOT require ICI interruption). The distinction between symptomatic and asymptomatic pancreatic enzyme elevation is one of the most important practical nuances in irAE management.

Reference: ESMO 2024 irAE Management; ASCO irAE Guidelines 2021