Killing Two Birds With One Stone: Effective Control of Both Non-Small Cell Lung Cancer and Progressive Multifocal Leukoencephalopathy With Atezolizumab, A Case Report

Abstract

Treating patients with cancer complicated by severe opportunistic infections is particularly challenging since classical cancer treatments, such as chemotherapy, often induce profound immune suppression and, as a result, may favor infection progression. Little is known about the potential place of immune checkpoint inhibitors in these complex situations. Here, we report a 66-year-old man who was concomitantly diagnosed with non-small cell lung cancer and progressive multifocal leukoencephalopathy. The patient was treated with anti-PD-L1 antibody atezolizumab, which allowed effective control of both lung cancer and progressive multifocal leukoencephalopathy, as demonstrated by the patient’s remarkable neurologic clinical improvement, JC viral load reduction in his cerebrospinal fluid, regression of the brain lesions visualized through MRI, and the strict radiological stability of his cancer. In parallel, treatment with atezolizumab was associated with biological evidence of T-cell reinvigoration. Hence, our data suggest that immune checkpoint inhibitors may constitute a treatment option for patients with cancer complicated by severe opportunistic infections.

Virus-Specific T-Cell Therapy for Viral Infections of the Central Nervous System: A Review

“…As there is no antiviral treatment proven effective for PML, the prognosis mainly relies on the ability to achieve timely immune reconstitution. In this line, several strategies aimed at reinvigorating anti-HPyV2 immune activity have recently emerged, including the use of immune checkpoint inhibitors, human recombinant interleukin 7, and polyomavirus-specific T-cell transfer [ 28 , 29 , 30 , 31 , 32 , 33 ].…”