Cochleovestibular toxicity induced by immune checkpoint inhibition: a case series

Lemasson, J.; Cuzzubbo, Stefania; Doucet, Ludovic; Gounant, V.; Baroudjian, Barouyr; Herms, F.; Carpentier, Antoine F.; Lebbe, Célèste; Vitaux, Hélène; Hautefort, Charlotte; Delyon, Julie

doi:10.1016/j.ejca.2019.05.022

Cited by 17 publications

(6 citation statements)

References 4 publications

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“…Another patient with normal hearing but bilateral vestibular deficit underwent vestibular rehabilitation while continuing IT. Her vestibular symptoms improved after 1 month 8 . The patient reported by Ziberlman et al received a total of six intratympanic steroid injections to the right ear and four to the left ear and had significant improvement in hearing bilaterally while continuing IT 7 .…”

Section: Discussionmentioning

confidence: 94%

“…Melanoma accounted for 60% of the primary tumors treated with ICIs, likely reflecting that this was the first disease in which ICIs were tested and approved. There was a slight female predominance (M:F ratio 2:3), and the median age was 55 years (range: 54‐82 years) 7,8 . Ototoxicity occurred in two patients receiving only one ICI agent.…”

Section: Discussionmentioning

confidence: 99%

“…This fact is explained by the rarity of this complication and is illustrated by the treatment heterogeneity found in the four previously reported cases. One patient with bilateral audiovestibular deficit received systemic steroids while continuing IT and had poor improvement in hearing after 2 months and no improvement of vestibular symptoms after 10 months 8 . Another patient with normal hearing but bilateral vestibular deficit underwent vestibular rehabilitation while continuing IT.…”

Section: Discussionmentioning

confidence: 99%

“…The patient reported by Ziberlman et al received a total of six intratympanic steroid injections to the right ear and four to the left ear and had significant improvement in hearing bilaterally while continuing IT 7 . ICIs were discontinued in only one case for concomitant grade III hepatitis, and there was resolution of hearing loss within 3 months without the use of steroids 8 . In the present case, there was marked improvement for each episode of sudden hearing loss with the use of systemic steroids and/or IT dexamethasone injection.…”

Section: Discussionmentioning

confidence: 99%

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Recurrent audiovestibular dysfunction and associated neurological immune‐related adverse events in a melanoma patient treated with nivolumab and ipilimumab

et al. 2020

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Background: Recurrent immunotherapy-induced audiovestibular toxicity despite cessation of therapy has not been reported. Methods: We report the first case of recurrent audiovestibular toxicity following immune-checkpoint inhibitor (ICI) therapy. The patient was seen with sudden bilateral hearing loss and disequilibrium. After ruling out other etiologies, he was diagnosed with audiovestibular and neurological immune-related adverse events (irAEs). He received systemic steroids, with significant hearing and balance recovery. Over the following 4 months, he experienced two other episodes of sudden bilateral hearing loss despite ICIs cessation. The second episode was treated with oral steroids, and hearing improved. On the third episode, he received oral and intratympanic steroids, and he was started on infliximab. Results: Audiogram 8 months following the last recurrence showed hearing improvement and stability. Conclusion: Immunotherapy-induced ototoxicity may recur despite therapy cessation. High dose steroids remain the mainstay of treatment. If audiovestibular irAEs recur despite multiple courses of steroids, immunosuppressive agents may be considered.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Recurrent audiovestibular dysfunction and associated neurological immune‐related adverse events in a melanoma patient treated with nivolumab and ipilimumab

et al. 2020

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“…Rarely, sequential or simultaneous bilateral vestibular neuritis, genetic disorders, vestibular atelectasis and semicircular canal anomalies may cause isolated BVP [1,18]. Immune checkpoint inhibitors targeting the cytotoxic T lymphocyte-associated antigen 4 and the programmed death protein 1 are increasingly used for patients with metastatic cancers [19]. Neurological adverse events occur in 3-12% and include BVP in addition to hearing loss, which may be reversible with discontinuation of medication or systemic corticosteroids [19,20].…”

Section: Isolated Bilateral Vestibulopathymentioning

confidence: 99%

Bilateral vestibulopathy: the causes, diagnosis, and treatments

Kim

2021

Current Opinion in Neurology

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Purpose of reviewThe current review covers recent advances in bilateral vestibulopathy (BVP) in terms of its etiology, diagnosis, and treatments. Recent findingsThe etiology of BVP depends on its clinical course and associated findings, and genetic abnormalities are increasingly recognized in isolated as well as complicated form of BVP. Recent developments in evaluation of the vestibular function have greatly enhanced the detection of BVP, and introduction of the consensus diagnostic criteria by Barany Society has facilitated research on BVP. Vestibular prosthesis may improve vestibular function, posture, gait and quality of life in patients with BVP and would expand the therapeutic options for BVP in near future. SummaryGenetics is expanding its role in identifying the causes of BVP of hitherto unknown etiology. The detection and investigation of BVP have been greatly enhanced by introduction of consensus diagnostic criteria and recent developments in methodology evaluating the vestibular function. Vestibular prothesis appears promising in managing BVP.

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The Impact of Monoclonal Antibody Usage on Hearing Outcomes: A Systematic Review

Arya,

Salmerón,

Quimby

et al. 2024

The Laryngoscope

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ObjectiveTo ascertain trends in ototoxicity observed with monoclonal antibodies (mABs) and understand the impact they may have on hearing function.Data SourcesPubMed, Embase, Scopus.Review MethodsA systematic review was performed following PRISMA guidelines. Data were reviewed for demographics, utilized mABs with respective indication and dosing, audiometric outcomes, and treatment for otologic effects.ResultsOf 757 studies reviewed, a total of 44 were included, encompassing 18,046 patients treated with mABs. Mean age of the sample was 57.8 years old. The search yielded 18 agents of ototoxicity, with reported symptoms of ototoxicity such as hearing loss, tinnitus, and/or aural fullness occurring in 1079 of total patients. Main agents causing ototoxicity were teprotumumab (n = 17/44 studies), nivolumab (n = 10/44), ipilimumab (n = 9/44), pembrolizumab (n = 5/44), and rituximab (n = 4/44). Thirty‐one of 44 studies encompassing eight agents reported audiometric data for ototoxic agents, showing sensorineural hearing loss primarily in the high‐frequency range. Only two articles performed ultrahigh‐frequency audiograms.ConclusionMonoclonal antibody usage is expanding, but the vast majority of studies lack substantial audiometric data. Where reported, study design and inclusion criteria vary greatly. Future studies would benefit from rigid inclusion of audiometric data, prospective study design, and consideration of formal ototoxicity screening. Otolaryngologists should be aware of the cochlear immune response and potential impact of this expanding medication class on hearing function. Laryngoscope, 2024

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Cochleovestibular toxicity induced by immune checkpoint inhibition: a case series

Cited by 17 publications

References 4 publications

Recurrent audiovestibular dysfunction and associated neurological immune‐related adverse events in a melanoma patient treated with nivolumab and ipilimumab

Recurrent audiovestibular dysfunction and associated neurological immune‐related adverse events in a melanoma patient treated with nivolumab and ipilimumab

Bilateral vestibulopathy: the causes, diagnosis, and treatments

The Impact of Monoclonal Antibody Usage on Hearing Outcomes: A Systematic Review

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