Immune checkpoint inhibitor-related cholangitis and pancreatitis induced by penpulimab: a case report

Background: In recent years, immunotherapy has been extensively employed in the treatment of various advanced malignant neoplasms, with immune checkpoint inhibitors (ICIs) representing the most prevalent form of this therapeutic approach. Penpulimab, a humanized monoclonal antibody, targets immunoglobulin G1 (IgG1) and binds to programmed cell death protein 1 (PD-1) receptors, blocking their interaction with programmed death-ligand 1 (PD-L1) and programmed death-ligand 2 (PD-L2), thereby inhibiting immunosuppressive activity. During the administration of ICIs, the overactivation of immune cells can lead to the unintended targeting of normal tissues and organs, resulting in immune-related adverse events (irAEs). Among these, immune-related cholangitis (IRC) and immune-related pancreatitis (IRP) are infrequent occurrences, seldom documented in the literature, and are often linked to unfavorable prognostic outcomes. Here, we present a case of penpulimab-associated cholangitis and Pancreatitis. Case Description: We report on a patient with recurrent gastric cancer post-surgery who was administered penpulimab at a dosage of 200 mg every 3 weeks. Following a 12-month course of penpulimab treatment, the patient exhibited jaundice, along with elevated serum bilirubin, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels. A liver biopsy revealed inflammatory changes in the bile ducts. Concurrently, the patient also developed pancreatitis. The patient's symptoms improved following pharmacological and surgical interventions. Conclusions: We present findings of cholangitis and pancreatitis linked to the antitumor application of penpulimab, an innovative immunosuppressant. This case provides significant Reference for the diagnosis and management of adverse complications associated with immunotherapy.