Has anyone seen/treated a case of immunotherapy induced hypertriglyceridemia? This week a patient presented for her 10th total Pembrolizumab dose and brought a concerning lipid panel to clinic that was obtained less than 2 weeks ago (TG 872, total cholesterol >650). We repeated the panel fasted lipid panel (TG 1343, total cholesterol 738). Amylase and lipase are normal, and she has no pancreatitis symptoms. I could only find case reports regarding IO hyperTG associated with pancreatitis, and the Merck MSL also was not aware of specific management. We have started her on fenofibrate, rosuvastatin, and fish oil and are rechecking her lipid panel next week. Our discussion was to try a prednisone taper if the labs do not improve, but I can't find any literature supporting this. Thanks in advance!
I have not seen it myself - glad to hear your patient doesn't have acute pancreatitis as that would be the most acute concern. Lipid lowering makes sense but I'm also not aware of any specific data on steroids acknowledging the scant data for IO-induced hypertriglyceridemia in the first place. Hope your patient's lipids improve at next check!
Please keep us posted! I don’t recall seeing a case like this. Very curious.
As a follow up, the medications worked quickly, and her TG resulted at 485 one week later! She never developed any symptoms of pancreatitis.
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