Asymptomatic Pembrolizumab-Associated Hypertriglyceridemia

Pembrolizumab is an immune checkpoint inhibitor that is widely used in the treatment of solid and hematological malignancies but is associated with immune-related adverse events. While the management of pembrolizumab-associated symptomatic hypertriglyceridemia associated with pancreatitis has been described, there is a lack of guidance for the treatment of pembrolizumab-associated asymptomatic hypertriglyceridemia. Here, we report a rare adverse event of pembrolizumab-associated asymptomatic hypertriglyceridemia after nine doses of pembrolizumab. The patient's lipid panel revealed grade 4 hypertriglyceridemia and hypercholesterolemia. Treatment was held, and the patient was treated with lipid-lowering therapies with improvement. Upon re-challenge, the grade 4 elevations returned while remaining asymptomatic. This case highlights a rare immune-related adverse event of asymptomatic hypertriglyceridemia. It underlines the importance of routine monitoring for adverse events with pembrolizumab, even in asymptomatic cases.