Hepatic and Pancreatobiliary Immune-Related Adverse Events in Patients Receiving Immune Checkpoint Inhibitors: A Multidisciplinary Approach

Parallel to the increased use of immune checkpoint inhibitors (ICIs), the incidence of immune-related adverse events (irAEs) is also increasing. Almost all organs can be affected by the immune-mediated response, including the liver, pancreas and biliary tract. Immune-Mediated Hepatitis is a common complication of ICI therapy, while cholangitis, cholecystitis and pancreatic involvement are less frequent. Emerging evidence from clinical trials and real-world data series helps us better understand the risk factors, diagnostic challenges and management strategies for these irAEs. With wider use of ICIs, more data are also available on the management of special populations with comorbidities and patients with difficult-to-treat or treatment-resistant adverse events, but larger prospective studies and more robust evidence are required for further recommendations on their management and ICI reintroduction. In clinical practice, a multidisciplinary approach to the management of ICI-mediated complications is advised, with close collaboration among specialties such as oncologists, gastroenterologists or hepatologists, pathologists, radiologists and others. While Immune-Mediated Hepatitis is a common irAE of ICI therapy, pancreato-biliary involvement is often overlooked and underdiagnosed. These irAEs require multimodal management, development of new biomarkers and prediction models to facilitate decision-making and improve patient outcomes.