Infliximab for Steroid-Refractory Immune Checkpoint Inhibitor-Induced Acute Pancreatitis

Matthew J Townsend; F Stephen Hodi; Shilpa Grover

doi:10.14309/crj.0000000000001018

Infliximab for Steroid-Refractory Immune Checkpoint Inhibitor-Induced Acute Pancreatitis

ACG Case Rep J. 2023 Mar 24;10(3):e01018. doi: 10.14309/crj.0000000000001018. eCollection 2023 Mar.

Authors

Matthew J Townsend¹, F Stephen Hodi^{2

3}, Shilpa Grover^{3

4}

Affiliations

¹ Department of Internal Medicine, Duke University Medical Center, Durham, NC.
² Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.
³ Harvard Medical School, Boston, MA.
⁴ Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, MA.

Abstract

Acute pancreatitis is an infrequent but clinically significant complication of immune checkpoint inhibitor (ICI) therapy. Guidelines recommend high-dose steroids and withdrawal of ICI in patients with severe ICI-induced pancreatitis. Management of steroid-refractory ICI pancreatitis is unclear. Infliximab is used to treat select extrapancreatic immune-related adverse events, but its role in ICI pancreatitis remains undefined. To our knowledge, we describe the first case of ICI pancreatitis successfully treated with infliximab after inadequate steroid response (recurrent pancreatitis on multiple attempted steroid tapers). Infliximab may be a viable treatment of steroid-refractory ICI pancreatitis. Further study of its potential effectiveness may improve guideline-directed care.

Keywords: immune checkpoint inhibitor; immune-related adverse event; infliximab; pancreatitis.

Publication types

Case Reports