Vasculitic neuropathy induced by pembrolizumab

Aya, Francisco; Ruíz-Esquide, Virginia; Viladot, Margarita; Font, Carme; Prieto-González, Sergio; Prat, Andrés; Arance, Ana

doi:10.1093/annonc/mdw613

Cited by 37 publications

(18 citation statements)

References 3 publications

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“…75,76 The reported neuropathy cases often closely resemble acute or chronic inflammatory demyelinating neuropathies 77 or vasculitic neuropathies. 78 Although they are considered rare, neurological side-effects may occur in up to 3% of patients. 75,76 Treatment of these side effects is discontinuation of the immune-enhancing chemotherapy and institution of immunotherapy (steroids and/or intravenous immunoglobulin), which is reported to be beneficial in many patients.…”

Section: Proteasome Inhibitorsmentioning

confidence: 99%

Chemotherapy‐induced peripheral neuropathy: A current review

Staff

Grisold

et al. 2017

Annals of Neurology

585

422

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Chemotherapy-induced peripheral neuropathy (CIPN) is a common dose-limiting side effect experienced by patients receiving treatment for cancer. Approximately 30–40% of patients treated with neurotoxic chemotherapy will develop CIPN and there is considerable variability in its severity between patients. It is often sensory-predominant with pain and can lead to long-term morbidity in survivors. The prevalence and burden of CIPN late effects will likely increase as cancer survival rates continue to improve. In this review, we discuss the approach to peripheral neuropathy in patients with cancer and address the clinical phenotypes and pathomechanisms of specific neurotoxic chemotherapeutic agents.

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Section: Proteasome Inhibitorsmentioning

confidence: 99%

Chemotherapy‐induced peripheral neuropathy: A current review

Staff

Grisold

et al. 2017

Annals of Neurology

585

422

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“…Immune-suppressant treatments, including IV and oral corticosteroids, immunoglobulin, and plasma exchange, are linked with partial recovery. 14 , 18 , 19 Recognition of the neurological complications associated with immune checkpoint inhibitor therapy is important, largely to avoid potentially harmful therapies, and to make determinations regarding potential chemotherapeutic cessation. To our knowledge, including a PubMed review, brachial neuritis associated with pembrolizumab and/or nivolumab therapy has not been reported.…”

Section: Discussionmentioning

confidence: 99%

“…The peripheral nervous system is especially vulnerable to immune-mediated neuromuscular complications caused by misdirected T-cell reactions. 13 Increasingly, case series have emerged that highlight the often severe peripheral nervous system complications that occur with these agents, including neuromuscular junction defects (myasthenia gravis), 14 , 15 muscle disease (necrotic myositis), 16 , 17 peripheral nerve vasculitis, 18 and acute demyelinating (Guillain-Barré syndrome) neuropathies. 19 Their identification and proper management are crucial in reducing morbidity and avoiding improper therapy for clinical mimics.…”

mentioning

confidence: 99%

Brachial Plexus Neuritis Associated With Anti–Programmed Cell Death-1 Antibodies: Report of 2 Cases

Alhammad

Dronca

Kottschade

et al. 2017

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Recently, guidelines have been outlined for management of immune-related adverse events occurring with immune checkpoint inhibitors in cancer, irrespective of affected organ systems. Increasingly, these complications have been recognized as including diverse neuromuscular presentations, such as demyelinating and axonal length–dependent peripheral neuropathies, vasculitic neuropathy, myasthenia gravis, and myopathy. We present 2 cases of brachial plexopathy developing on anti–programmed cell death-1 checkpoint inhibitor therapies (pembrolizumab, nivolumab). Both cases had stereotypic lower-trunk brachial plexus–predominant onsets, and other clinical features distinguishing them from Parsonage-Turner syndrome (ie, idiopathic plexitis). Each case responded to withholding of anti–programmed cell death-1 therapy, along with initiation of high-dose methylprednisiolone therapy. However, both patients worsened when being weaned from corticosteroids. Discussed are the complexities in the decision to add a second-line immunosuppressant drug, such as infliximab, when dealing with neuritis attacks, for which improvement may be prolonged, given the inherent slow recovery seen with axonal injury. Integrated care with oncology and neurology is emphasized as best practice for affected patients.

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“…Another review identified 53 cases of vasculitis associated with the use of an ICPi, of which 20 were confirmed cases . Small‐, medium‐, and large‐vessel vasculitides affecting numerous organs including the skin, large vessels, and peripheral nerves have been reported . In addition to PMR, other forms of inflammatory arthritis have been described including small joint polyarthritis mimicking rheumatoid arthritis and large joint oligo‐articular arthritis mimicking the seronegative spondyloarthropathies .…”

Section: Rheumatic Toxicitymentioning

confidence: 99%

Diagnosis and Management of Rare Immune-Related Adverse Events

et al. 2019

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Oncologic treatment is being revolutionized by a burgeoning number of immune checkpoint inhibitors (ICPis). To date, seven ICPis have received Food and Drug Administration approval, targeting cytotoxic T-lymphocyte antigen, programmed cell death, or programmed cell death ligand. Adverse events associated with checkpoint inhibition have been described in the literature. Guidelines exist for the most common of these, but as the use of ICPis becomes more common, the number of patients presenting with rare events will increase. This article reviews the diagnosis and management of rare ocular, hematological, luminal gastrointestinal, and rheumatological toxicities arising from ICPi treatment. The Oncologist 2020;25:6-14 KEY POINTS• As the use of immune checkpoint inhibitors (ICPis) becomes more common, the number of rare immune-related adverse events (irAEs) will increase. A high level of suspicion is required to identify and treat these toxicities. • Although it can be difficult to definitively attribute rare irAEs to ICPis, a temporal and mechanistic relationship and the absence of other etiologies should make the treating physician suspicious for a rare irAE. • Certain rare irAEs, such as celiac disease, do not require treatment with glucocorticoids. Thus, differentiating this irAE from other gastrointestinal irAEs has important implications for treatment.

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Vasculitic neuropathy induced by pembrolizumab

Cited by 37 publications

References 3 publications

Chemotherapy‐induced peripheral neuropathy: A current review

Chemotherapy‐induced peripheral neuropathy: A current review

Brachial Plexus Neuritis Associated With Anti–Programmed Cell Death-1 Antibodies: Report of 2 Cases

Diagnosis and Management of Rare Immune-Related Adverse Events

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