Ipilimumab and Nivolumab-Induced Pancreatitis and Hepatitis in Malignant Melanoma

Immune checkpoint inhibitors are an effective therapy option for patients with high immunogenicity malignancies, tumors that express checkpoint proteins that send an “off” signal to the body’s T cells [1]. Altering the activity of T cells can help improve killing of cancer cells at the consequence of losing their ability to identify host cells. As a result, Immune-Related Adverse Effects (irAE) can occur [2]. We present a case of ipilimumab and nivolumab-induced pancreatitis and hepatitis in a woman who was treated for malignant melanoma. After two cycles of ipilimumab and nivolumab, the patient was admitted for abdominal pain, fever, and weakness, with workup revealing elevated transaminases, hyperbilirubinemia, elevated amylase, and elevated lipase. A diagnosis was made for immunotherapy-induced hepatitis and pancreatitis. Combination immunotherapy was discontinued. Treatment with oral steroids was initiated with minimal response. Mycophenolate mofetil was started and later transitioned to tacrolimus immunosuppression due to progressive neutropenia, and ultimately tapered off completely with resolution of clinical and laboratory symptoms.  Early identification and prompt treatment of irAE such as pancreatitis can lead to decreased long-term consequences and morbidity including diabetes and chronic pancreatitis.