Cisplatin/etoposide/pembrolizumab

Abstract

Cisplatin/etoposide/pembrolizumabParaneoplastic sensorimotor neuronopathy and lack of efficacy: case report A 56-year-old man developed polyradiculoneuropathy, paraneoplastic sensory neuronopathy, and transmural colitis during treatment with pembrolizumab for metastatic lung cancer. Additionally, he exhibited lack of efficacy with cisplatin and etoposide while being treated for lung cancer [routes not stated; not all dosages stated].The man, who was diagnosed with metastatic lung cancer received treatment with cisplatin and etoposide as the first-line chemotherapy. However, it was not effective (lack of efficacy with cisplatin and etoposide). Then he received treatment with pembrolizumab 200mg as a second-line treatment. He received three doses of 200mg pembrolizumab. After 20 days of third dose, he presented with bloody stool, muscle weakness, and pain in his extremities. Blood tests showed elevated leucocytes count and Creactive protein. Colonic oedema was observed on abdominal CT and colitis was revealed by total colonoscopy. Electromyography showed abundant fibrillations and fasciculations of the upper and lower extremities and severe reduction in motor unit potentials. He also developed sub-acute dysesthesia.The man was treated with methylprednisolone, meropenem and infliximab. He also developed colonic perforations for which, he underwent a total colorectal resection. Histopathological study of the resected part revealed transmural colitis, mucosal defect and perforation. Immunohistochemical staining showed that inflammatory cells were positive for CD45. His muscle weakness and respiratory failure and remained after colorectal resection. After 58 days of admission, he died of lung aspergillosis. Two hours after his death, autopsy was performed. It revealed polyradiculoneuropathy along with severe CD8-positive lymphocytic infiltration around the neurons. These findings were consistent with paraneoplastic sensorimotor neuronopathy.