A case series of PD-1 inhibitor-associated paraneoplastic neurologic syndromes

J Neuroimmunol. 2019 Sep 15:334:576980. doi: 10.1016/j.jneuroim.2019.576980. Epub 2019 Jun 5.

Abstract

Immune checkpoint inhibitors (ICIs) are highly efficacious for treating many solid tumor types. Because of their immune-activating mechanism of action, ICIs can trigger various immune-mediated toxicities. We present three cases: i) a woman with anti-Ri brainstem encephalitis; ii) a man with anti-Hu sensory neuronopathy; and iii) a woman with suspected combined anti-Hu and anti-NMDA paraneoplastic syndromes associated with the initiation of the ICIs pembrolizumab and nivolumab. These cases suggest that ICIs can induce both humoral and cell-mediated paraneoplastic neurologic syndromes. Identifying biomarkers that predict risk of developing ICI-associated paraneoplastic syndromes and the development of efficacious treatment strategies for neurologic ICI-toxicities are critical unmet needs.

Keywords: Antibodies; Autoimmune; Immune checkpoint inhibitors; Nivolumab; Paraneoplastic; Pembrolizumab.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antibodies, Monoclonal, Humanized / adverse effects*
  • Antibodies, Monoclonal, Humanized / pharmacology
  • Antineoplastic Agents, Immunological / adverse effects
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nivolumab / adverse effects*
  • Nivolumab / pharmacology
  • Paraneoplastic Syndromes, Nervous System / blood
  • Paraneoplastic Syndromes, Nervous System / chemically induced*
  • Paraneoplastic Syndromes, Nervous System / diagnostic imaging*
  • Programmed Cell Death 1 Receptor / antagonists & inhibitors*
  • Programmed Cell Death 1 Receptor / blood

Substances

  • Antibodies, Monoclonal, Humanized
  • Antineoplastic Agents, Immunological
  • PDCD1 protein, human
  • Programmed Cell Death 1 Receptor
  • Nivolumab
  • pembrolizumab