Overlapping NMDA-R and GFAP Antibody Autoimmune Encephalitis After Nivolumab Therapy

Abstract

Immunotherapy represents a rapidly expanding area of cancer treatment. Immune checkpoint inhibitors (ICIs), monoclonal antibodies including those targeting cytotoxic T-lymphocyte associated protein 4 or the programmed cell death receptor-1 (PD-1) axis, function by removing inhibitory signals on T-cell activation 1. While promoting T-cell mediated tumor lysis, ICI’s alter the immune system’s regulatory checkpoints which can lead to a host of immune-related adverse events (irAEs) 2, 3. Here, we describe a patient treated with nivolumab (Opdivo, Bristol-Myers Squibb, Princeton, New Jersey) for non-small-cell lung carcinoma (NSCLC) over two years who developed overlapping n-methyl-D-aspartate receptor (NMDA-R) and glial fibrillary acidic protein (GFAP) antibody associated autoimmune encephalitis (AE)4. His hospital course was further complicated by dysautonomia responsive to high-dose steroids.

IgA Nephropathy Secondary to Ipilimumab Use

“…Despite the efficacy of CPIs, immune-related adverse events (irAEs) are well documented and numerous, with dermatitis, enterocolitis, hypophysitis, cytopenias, and autoimmune encephalitis reported most commonly [ 4 , 5 , 6 , 7 ]. These irAEs can occur at any point during a patient's treatment course, and the mainstays of therapy are discontinuation of the offending agent and corticosteroids.…”

Drug‐induced immune‐mediated thrombocytopenia secondary to durvalumab use

“…As a checkpoint inhibitor (CPI), durvalumab targets and blocks programmed death ligand 1 (PD‐L1) on tumor cells, resulting in increased T‐cell activation and destruction of cancer cells 3,4 . While CPIs are an expanding area of cancer treatment with significant promise, multiple side effects of treatment, or immune‐related adverse events (irAE), have been reported 5‐7 . Cytopenias have also been reported with CPI use, and for durvalumab specifically, have been noted to occur in less than 1% of individuals treated 8…”