Immune-related pancreatitis secondary to nivolumab in a patient with recurrent lung adenocarcinoma: A case report

Immune checkpoint inhibitor is a verified standard of care as a second-line chemotherapy for non-small cell lung cancer. Management of immune-related adverse effects (irAEs) is crucial for ensuring patient safety. However, less frequent irAEs may result in complications. Here, we report a patient with recurrent lung adenocarcinoma who was treated with nivolumab and developed immune-related pancreatitis. A 66-year-old Japanese female with recurrent lung adenocarcinoma and metastatic lymph nodes presented with anorexia, vomiting, and back pain on day 18 of two cycles of nivolumab. Laboratory data demonstrated a grade 3 elevation of serum amylase and lipase levels. Initially, no abnormality could be detected on computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP), or the Gallium scan. The patient was treated with high-dose prednisone, resulting in gradual improvement of symptoms and laboratory data. A follow-up MRCP revealed a swollen pancreas and pancreatic inflammation. Immune-related pancreatitis is a rare type of nivolumab-induced irAE that shows no significant changes on radiologic imaging, except for a swollen pancreas on CT, and can be suppressed using high-dose prednisone. (C) 2016 Elsevier Ireland Ltd. All rights reserved.