Pancreatitis in Patients with Cancer Receiving Immune Checkpoint Inhibitors: A Systematic Review and Meta-analysis.

IF 4.4 3区医学 Q2 ONCOLOGY

Targeted Oncology Pub Date : 2024-11-01 Epub Date: 2024-10-11 DOI:10.1007/s11523-024-01098-1

Mako Koseki, Yoshito Nishimura, Evelyn Elias, Jonathan Estaris, Fnu Chesta, Kensuke Takaoka, Theresa Shao, Nobuyuki Horita, Yu Fujiwara

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引用次数: 0

Abstract

Background: Immune checkpoint inhibitors (ICIs) occasionally cause immune-related adverse events (AEs), which pose challenges to the continuation of treatment. Although ICIs are widely used in patients with cancer, studies reporting immune-mediated pancreatitis remain scarce.

Objectives: We performed a systematic review and meta-analysis to address current knowledge gaps and provide clinical guidance for ICI-associated pancreatitis and lipase elevation.

Patients and methods: We searched PubMed/Medline, Embase, and Web of Science for phase 3 randomized controlled trials (RCTs) evaluating ICIs. The incidence of any-grade and grade 3-5 pancreatitis/lipase elevation was calculated. Then, we performed a random-effect model meta-analysis to pool the odds ratios (ORs) of these outcomes using RCTs evaluating the addition of an ICI to systemic therapy to assess the effect of ICIs on pancreatic AEs. A systematic review of the treatment of ICI-related pancreatitis was also conducted.

Results: The incidence analysis included 81 articles (79 RCTs) comprising 36,871 patients. The incidence of treatment-related pancreatitis was 0.68% (any-grade) and 0.32% (grade 3-5). Meta-analysis revealed that the addition of ICI therapy significantly increased any-grade (OR 2.12, 95% confidence interval [CI] 1.45-3.11, p < 0.001) and grade 3-5 pancreatitis (OR 1.76, 95% CI 1.01-3.08, p < 0.05) with low heterogeneity among ICI subtype subgroups (any-grade: I² = 0%, p = 0.99; grade 3-5: I² = 0%, p = 0.63). In analysis of treatment outcome among 146 patients from 53 articles, glucocorticoids were used in 80.6% (n = 108/134) and ICIs were discontinued in 76.5% (n = 101/132; permanent discontinuation: 62.5% [n = 35/56]).

Conclusions: The overall rate of pancreatitis appears low, but the addition of ICI therapy significantly increased the incidence of pancreatitis. These findings provide insight into the incidence and treatment of pancreatitis associated with ICIs.

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接受免疫检查点抑制剂治疗的癌症患者的胰腺炎：系统回顾与元分析》。

背景：免疫检查点抑制剂（ICIs）偶尔会引起免疫相关不良事件（AEs），给继续治疗带来挑战。尽管 ICIs 广泛用于癌症患者，但报告免疫介导的胰腺炎的研究仍然很少：我们进行了一项系统综述和荟萃分析，以填补目前的知识空白，并为 ICI 相关性胰腺炎和脂肪酶升高提供临床指导：我们检索了PubMed/Medline、Embase和Web of Science中评估ICI的3期随机对照试验（RCT）。我们计算了任何级别和 3-5 级胰腺炎/脂肪酶升高的发生率。然后，我们进行了随机效应模型荟萃分析，将这些结果的几率比（ORs）汇集到评估在全身治疗中添加 ICI 的 RCT 中，以评估 ICI 对胰腺 AEs 的影响。此外，还对 ICI 相关胰腺炎的治疗进行了系统综述：发病率分析包括81篇文章（79项RCT），涉及36871名患者。治疗相关性胰腺炎的发生率为 0.68%（任何等级）和 0.32%（3-5 级）。Meta 分析显示，加用 ICI 治疗会显著增加任何等级（OR 2.12，95% 置信区间 [CI]1.45-3.11，p < 0.001）和 3-5 级胰腺炎（OR 1.76，95% CI 1.01-3.08，p < 0.05）的发生率，ICI 亚型分组间的异质性较低（任何等级：I2 = 0%，p = 0.99；3-5 级：I2 = 0%，p = 0.63）。在对53篇文章中146名患者的治疗结果进行分析时，80.6%的患者使用了糖皮质激素（n = 108/134），76.5%的患者停用了ICIs（n = 101/132；永久停用：62.5% [n = 35/56]）：结论：胰腺炎的总体发病率似乎较低，但增加 ICI 治疗会显著增加胰腺炎的发病率。这些研究结果为了解与 ICIs 相关的胰腺炎的发病率和治疗方法提供了启示。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Targeted Oncology 医学-肿瘤学

CiteScore

8.40

自引率

3.70%

发文量

审稿时长

>12 weeks

期刊介绍： Targeted Oncology addresses physicians and scientists committed to oncology and cancer research by providing a programme of articles on molecularly targeted pharmacotherapy in oncology. The journal includes: Original Research Articles on all aspects of molecularly targeted agents for the treatment of cancer, including immune checkpoint inhibitors and related approaches. Comprehensive narrative Review Articles and shorter Leading Articles discussing relevant clinically established as well as emerging agents and pathways. Current Opinion articles that place interesting areas in perspective. Therapy in Practice articles that provide a guide to the optimum management of a condition and highlight practical, clinically relevant considerations and recommendations. Systematic Reviews that use explicit, systematic methods as outlined by the PRISMA statement. Adis Drug Reviews of the properties and place in therapy of both newer and established targeted drugs in oncology.