Acute demyelinating polyneuropathy induced by nivolumab

Fukumoto, Yuta; Kuwahara, Motoi; Kawai, Shigeto; Nakahama, Kenji; Kusunoki, Susumu

doi:10.1136/jnnp-2017-316510

Cited by 34 publications

(16 citation statements)

References 5 publications

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“…Of these, four patients received nivolumab in combination with ipilimumab, and one patient received nivolumab in combination with pembrolizumab. In the above cases, the types of tumor the patients suffered from were melanoma ( n = 20) [ 13 , 14 , 16 , 17 , 23 , 24 , 28 , 29 , 31 – 37 , 39 – 42 ], lung tumor ( n = 7) [ 18 , 21 , 25 , 26 , 28 , 30 , 38 ], urinary tumor ( n = 5) [ 13 , 15 , 19 , 20 , 22 ], and nasal cancer ( n = 1) [ 27 ]. The details were summarized in Tables 4 and 5 .…”

Section: Resultsmentioning

confidence: 99%

Guillain‐Barré Syndrome‐Like Polyneuropathy Associated with Immune Checkpoint Inhibitors: A Systematic Review of 33 Cases

Zhang

Zhao

2021

BioMed Research International

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Immune checkpoint inhibitors (ICIs) have been increasingly used in the treatment of various types of tumors with favorable results. But these treatments also led to a variety of immune-related adverse events (irAEs). Neurological irAEs such as Guillain-Barré Syndrome are rare and may have serious consequences once they occur. A systematic literature search was performed in PubMed and Embase for all case reports of GBS associated with ICIs published in English reporting on human beings from 1990 up to date. A total of 30 case reports ( total patients = 33 ) were used for final analysis. The included cases were from 11 countries, covering 10 tumor types, with melanoma accounting for the largest number. The mean age was 62.2 ± 11.1 years old, and males were dominant (male: 26 and female: 7). The median time of initial symptoms was 8.2 weeks after the 1st dose of ICIs. The most common manifestations of GBS associated with ICIs were weakness, hyporeflexia or areflexia, and paresthesia in order. The GBS subtypes suggested by electrophysiological results were acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN), and Miller Fisher syndrome (MFS). The protein level of CSF in patients with GBS related to ICIs was 180.68 ± 152.51 mg/dl. Immediate termination of ICIs followed by intravenous immunoglobulin was the preferred treatment option. 72.7% of patients recovered or had residual mild dysfunction after treatment. Elderly male patients with melanoma were most likely to develop ICI-related GBS. The specific neurological symptoms, CSF analysis, and electrophysiological examination were important means of diagnosis.

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Section: Resultsmentioning

confidence: 99%

Guillain‐Barré Syndrome‐Like Polyneuropathy Associated with Immune Checkpoint Inhibitors: A Systematic Review of 33 Cases

Zhang

Zhao

2021

BioMed Research International

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“…1 Although antiganglioside antibodies were negative in our case, PD-1 inhibitor-related AIDP was reportedly positive for GM2 and GalNAc-GD1a antibodies. 7 Although skin toxicity is one of the most frequent irAEs, itching, erythema, papules, and vitiligo are common; however, reports of grade 3 to 4 events, such as SJS and TEN, are rare. 8 TEN is more frequently associated with anti-PD-1 therapy than with other anticancer drugs 9,10 and permanent discontinuation of immunotherapy, in the setting of severe or life-threatening bullous disease (grade3-4) as irAE, including all cases of SJS and TEN.…”

Section: Discussionmentioning

confidence: 99%

A Case of Guillain-Barré Syndrome and Stevens-Johnson Syndrome/Toxic Epidermal Necrosis Overlap After Pembrolizumab Treatment

Oguri

Sasada

Shimizu

et al. 2021

Journal of Investigative Medicine High Impact Case Reports

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A 76-year-old man was admitted to our hospital with Guillain-Barré syndrome (GBS), presenting with facial palsy, dysarthria, and dysphagia as Grade 3 immune-related adverse events (irAEs) due to pembrolizumab administration for Stage IV lung adenocarcinoma. Although prednisolone (1 mg/kg) was started for GBS due to the irAE, dark erythema and skin eruptions appeared on the patient’s torso. Then erosion was observed on 18% of the body surface area and skin biopsy was performed. Finally, the patient was diagnosed with Stevens-Johnson syndrome/toxic epidermal necrosis overlap. Intravenous immunoglobulin therapy was started, and the skin symptoms improved, with the erosion becoming epithelial. He died of aspiration pneumonia related to GBS, although his neurological symptoms had improved after steroid and intravenous immunoglobulin therapy. This is the first reported case of pembrolizumab-induced GBS and Stevens–Johnson syndrome/toxic epidermal necrosis overlap. It is necessary to be careful that the possibility of other severe irAEs may occur simultaneously.

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“…CSF and EMG analysis are critical diagnostics steps. IVIG (intravenous immunoglobulin), plasmapheresis and glucocorticoid treament are effective therapies for ICI-related GBS [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] .…”

Section: Discussionmentioning

confidence: 99%

“…16 ICI-related GBS patients (15 publications) were found via PubMed with median age 63 years (range: 45-81 years) [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] , including 1 bladder, 1 nasal, 1 kidney, 5 lung and 8 melanoma cancer patients. Male patients accounted for 75%.…”

Section: Discussionmentioning

confidence: 99%

Guillain-Barre Syndrome Caused by Tislelizumab and Axitinib

Sun

Guo

Ya-qing

et al. 2021

Preprint

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Immunotherapy combinations have changed the treatment paradigm of advanced renal cell carcinoma (RCC). Notably, immunotherapy induces a new spectrum of immune-related adverse events (irAEs). Guillain–Barré syndrome (GBS) is a rare and potentially fatal nervous system irAE. The activation of T-cell is considered a triggering factor of GBS. We herein reported a case of GBS-like syndrome during treatment of tislelizumab and axitinib in a patient with RCC. To our knowledge, this is the first report of tislelizumab-related GBS.

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Acute demyelinating polyneuropathy induced by nivolumab

Cited by 34 publications

References 5 publications

Guillain‐Barré Syndrome‐Like Polyneuropathy Associated with Immune Checkpoint Inhibitors: A Systematic Review of 33 Cases

Guillain‐Barré Syndrome‐Like Polyneuropathy Associated with Immune Checkpoint Inhibitors: A Systematic Review of 33 Cases

A Case of Guillain-Barré Syndrome and Stevens-Johnson Syndrome/Toxic Epidermal Necrosis Overlap After Pembrolizumab Treatment

Guillain-Barre Syndrome Caused by Tislelizumab and Axitinib

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