Pancreas and Gallbladder

Immune checkpoint blockade offers a revolutionary oncologic treatment strategy by modulating the T-cell pathway in order to enhance and enable immune-mediated antitumor responses. However, blockade of certain checkpoints, namely CTLA-4 (cytotoxic T-lymphocyte-associated protein 4), PD-1 (programmed cell death protein 1), and PD-L1 (programmed cell death-ligand 1), can lead to enhancement of normal immunity, which may inadvertently cause immune-related adverse events (irAEs) primarily due to the dampening of normal protective immune tolerance [1]. Immune checkpoint inhibitor-mediated pancreas and gallbladder injuries are infrequent. The most common manifestation of the effects on the pancreas is asymptomatic elevation of pancreatic enzymes. In symptomatic cases, clinical presentations and management may resemble that of acute pancreatitis and cholecystitis. The role of steroid therapy in the management of these toxicities is yet to be elucidated. Long-term complications, albeit rare, are associated with better overall survival in this group of patients.