Immune mediated neuropathy following checkpoint immunotherapy. (November 2017)

• Record Type: Journal Article
• Authors: Gu, Yufan; Menzies, Alexander M.; Long, Georgina V.; Fernando, S.L.; Herkes, G.
• Is Part Of: Journal of clinical neuroscience. Volume 45(2017:Nov.)
• Page Start: 14
• Page End: 17
• Publication Date: 2017-11
• Subjects: Checkpoint immunotherapy -- CTLA-4, PD-1 -- Ipilimumab -- Nivolumab -- Neuropathy -- Guillain-Barre; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2017.07.014
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Neuropathies are rare but potentially severe complications of checkpoint immunotherapy. Neurophysiology can show an axonal or demyelinating pattern. Cerebrospinal fluid often shows a lymphocytic pleocytosis. Immunotherapy varies, but should include corticosteroid therapy. Abstract: Checkpoint immunotherapy has revolutionised cancer therapy and is now standard treatment for many malignancies including metastatic melanoma. Acute inflammatory neuropathies, often labelled as Guillain-Barre syndrome, are an uncommon but potentially severe complication of checkpoint immunotherapy with individual cases described but never characterised as a group. We describe a case of acute sensorimotor and autonomic neuropathy following a single dose of combination ipilimumab and nivolumab for metastatic melanoma. A literature search was performed, identifying 14 other cases of acute neuropathy following checkpoint immunotherapy, with the clinical, electrophysiological and laboratory features summarised. Most cases described an acute sensorimotor neuropathy (92%) with hyporeflexia (92%) that could occur from induction up till many weeks after the final dose of therapy. In contrast to Guillain-Barre syndrome, the cerebrospinal fluid (CSF) analysis often shows a lymphocytic picture (50%) and the electrophysiology showed an axonal pattern (55%). Treatment was variable and often in combination. 11 cases received steroid therapy with only 1 death within this group, whereas of the 4 patients who did not receive steroid therapy there were 3 deaths. In conclusion checkpoint immunotherapy – induced acute neuropathies are distinct from and progress differently to Guillain-Barre syndrome. As with other immunotherapy related adverse events corticosteroid therapy should be initiated in addition to usual therapy.