TY - JOUR
T1 - Neuromuscular weakness syndromes from immune checkpoint inhibitors
T2 - A case series and literature review
AU - Daher, Ahmad
AU - Matsuoka, Carlos Kamiya
AU - Loghin, Monica Elena
AU - Penas-Prado, Marta
AU - Tummala, Sudhakar
N1 - Publisher Copyright:
© 2019 Journal of Immunotherapy and Precision Oncology | Published by Wolters Kluwer-Medknow.
PY - 2019
Y1 - 2019
N2 - Immune checkpoint inhibitors (CPIs) (anti-cytotoxic T-lymphocyte antigen-4, anti-programmed death 1, and anti-programmed death-ligand 1) have transformed the landscape of cancer therapy. However, their increasing use has unleashed immune-related adverse events in various organs, among which neurologic ones, while rare, are increasingly being recognized and remain incompletely characterized. Herein, we report five patients with nonmelanoma cancers who developed weakness after receiving CPIs. The etiology was attributed to radiculoneuritis (one patient), myositis (one patient), Miller Fisher/myasthenia gravis (MG) (one patient), neuropathy/myositis/MG (one patient), and myositis/MG (one patient). Weakness developed after a median of two doses (range: 1–3) and 4 weeks (range: 3–10) from initiation of therapy. Two patients had severe manifestations without improvement while the other three experienced partial improvement despite discontinuation of the CPI (s) and initiation of immunosuppressive therapy. A review of literature identified 62 similar cases. This report highlights the challenges in the diagnosis and management of neurologic adverse events related to the use of CPIs. It also addresses the crucial need for early recognition, proper workup, and better biomarkers to help improve the outcomes of these adverse events.
AB - Immune checkpoint inhibitors (CPIs) (anti-cytotoxic T-lymphocyte antigen-4, anti-programmed death 1, and anti-programmed death-ligand 1) have transformed the landscape of cancer therapy. However, their increasing use has unleashed immune-related adverse events in various organs, among which neurologic ones, while rare, are increasingly being recognized and remain incompletely characterized. Herein, we report five patients with nonmelanoma cancers who developed weakness after receiving CPIs. The etiology was attributed to radiculoneuritis (one patient), myositis (one patient), Miller Fisher/myasthenia gravis (MG) (one patient), neuropathy/myositis/MG (one patient), and myositis/MG (one patient). Weakness developed after a median of two doses (range: 1–3) and 4 weeks (range: 3–10) from initiation of therapy. Two patients had severe manifestations without improvement while the other three experienced partial improvement despite discontinuation of the CPI (s) and initiation of immunosuppressive therapy. A review of literature identified 62 similar cases. This report highlights the challenges in the diagnosis and management of neurologic adverse events related to the use of CPIs. It also addresses the crucial need for early recognition, proper workup, and better biomarkers to help improve the outcomes of these adverse events.
KW - Checkpoint inhibitor
KW - Immunotherapy
KW - Myasthenia gravis
KW - Myositis
KW - Neurotoxicity
UR - http://www.scopus.com/inward/record.url?scp=85091005759&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85091005759&partnerID=8YFLogxK
U2 - 10.4103/JIPO.JIPO_3_19
DO - 10.4103/JIPO.JIPO_3_19
M3 - Review article
AN - SCOPUS:85091005759
SN - 2666-2345
VL - 2
SP - 93
EP - 100
JO - Journal of Immunotherapy and Precision Oncology
JF - Journal of Immunotherapy and Precision Oncology
IS - 3
ER -