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

Alhammad, Reem; Dronca, R.; Kottschade, Lisa A.; Turner, Heidi J.; Staff, Nathan P.; Mauermann, Michelle L.; Tracy, Jennifer A.; Klein, Christopher J.

doi:10.1016/j.mayocpiqo.2017.07.004

Cited by 23 publications

(13 citation statements)

References 22 publications

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“…More rarely, immune‐related peripheral neuropathies may manifest as isolated cranial neuropathies, lumbar or brachial plexopathy, enteric plexus neuropathy, or peripheral nervous system vasculitis …”

Section: Clinical Syndromes and Presentationsmentioning

confidence: 99%

Immune checkpoint inhibitors‐induced neuromuscular toxicity: From pathogenesis to treatment

Psimaras

Velasco

Birzu

et al. 2019

J Peripheral Nervous Sys

122

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Immune checkpoint inhibitors (ICIs) are increasingly used and are becoming the standard of care in the treatment of various tumor types. Despite the favorable results in terms of oncological outcomes, these treatments have been associated with a variety of immune-related adverse events (irAEs). Neurological irAEs are rare but potentially severe. Neuromuscular disorders represent the most common neurological irAEs following anti-PD-1, anti-PD-L1, and anti-CTLA-4 treatment, and include myositis, myasthenia gravis, and demyelinating polyradiculoneuropathy. Instrumental findings may differ from typical neuromuscular disorders occurring outside ICIs treatment.Despite initial severity, neurological irAEs often respond to immune-modulating therapies. Prompt irAEs diagnosis, ICIs discontinuation, and early treatment with corticosteroids, together with patient education and a multi-disciplinary approach, are important for optimizing clinical outcomes. Intravenous immunoglobulin, plasma exchange, and other immune-modulating treatments should be considered in more severe cases. Consideration of re-challenging with the same immunotherapy drug may be given in some cases, based on clinical picture and initial severity of irAEs. K E Y W O R D SCTLA-4, demyelinating polyradiculoneuropathy, immune checkpoint inhibitor, myasthenia gravis, myositis, nivolumab, PD-1, PD-L1, pembrolizumab, peripheral neuropathy

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Section: Clinical Syndromes and Presentationsmentioning

confidence: 99%

Immune checkpoint inhibitors‐induced neuromuscular toxicity: From pathogenesis to treatment

Psimaras

Velasco

Birzu

et al. 2019

J Peripheral Nervous Sys

122

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“…As in Cases #4 and #5, brachial plexus neuritis after PD-1 antibody treatment was reported in one patient after nine infusions of pembrolizumab, and in another patient after nine infusions of nivolumab both with a rebound of symptoms when weaned from corticosteroids and with a rapid response to corticosteroids and a full regaining of function [27]. Compared to idiopathic pathogenesis, ICI-induced plexus neuropathies develop with an acute onset and seem to predominantly affect the lower trunk and muscle atrophy is absent; pain and motor and sensory symptoms respond immediately to high-dose corticosteroids [27].…”

Section: Discussionmentioning

confidence: 60%

Detect it so you can treat it: a case series and proposed checklist to detect neurotoxicity in checkpoint therapy

Bolz

Ramakrishnan

Fleischer

et al. 2020

Preprint

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Background: Checkpoint inhibitors show impressive and durable responses in various cancer types and provide new avenues for cancer immunotherapy. However, these drugs have a variety of adverse events. Common autoimmune-related adverse effects include fatigue, hepatitis, skin rash, endocrine deficiencies, and colitis. Neurotoxicity has been reported, but its incidence and course remain unclear.Methods: To illustrate the broad spectrum of neurotoxicity, we exemplarily report the neurological adverse events of five patients with melanoma and one patient with differentiated thyroid cancer who received checkpoint inhibitors at Essen University Hospital (Essen, Germany).Results: After treatment with ipilimumab, nivolumab or pembrolizumab, neurotoxic effects included hypophysitis-associated neck pain and headache, Guillain-Barré syndrome, transverse myelitis, acute brachial plexus neuritis, and ocular myasthenia gravis.Conclusions: Checkpoint inhibitor therapy remains a success story; however, neurological immune-related adverse events may cause severe life-threatening conditions. We propose a checklist for the early detection of neurological adverse events during routine clinical treatment to prevent more severe courses of checkpoint inhibitor-induced neurotoxicity.

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“…As in Cases #4 and #5, brachial plexus neuritis after PD-1 antibody treatment was reported in one patient after nine infusions of pembrolizumab, and in another patient after nine infusions of nivolumab both with a rebound of symptoms when weaned from corticosteroids and with a rapid response to corticosteroids and a full regaining of function [ 35 ]. Compared to idiopathic pathogenesis, ICI-induced plexus neuropathies develop with an acute onset and seem to predominantly affect the lower trunk and muscle atrophy is absent; pain and motor and sensory symptoms respond immediately to high-dose corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

Detect it so you can treat it: A case series and proposed checklist to detect neurotoxicity in checkpoint therapy

et al. 2021

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Background Checkpoint inhibitors show impressive and durable responses in various cancer types and provide new avenues for cancer immunotherapy. However, these drugs have a variety of adverse events. Common autoimmune-related adverse effects include fatigue, hepatitis, skin rash, endocrine deficiencies, and colitis. Neurotoxicity has been reported, but its incidence and course remain unclear. Methods To illustrate the broad spectrum of neurotoxicity, we exemplarily report the neurological adverse events of five patients with melanoma and one patient with differentiated thyroid cancer who received checkpoint inhibitors at Essen University Hospital (Essen, Germany). Results After treatment with ipilimumab, nivolumab or pembrolizumab, neurotoxic effects included hypophysitis-associated neck pain and headache, Guillain-Barré syndrome, transverse myelitis, acute brachial plexus neuritis, and ocular myasthenia gravis. Conclusions Checkpoint inhibitor therapy remains a success story; however, neurological immune-related adverse events may cause severe life-threatening conditions. We propose a guide for the early detection of neurological adverse events during routine clinical treatment to prevent more severe courses of checkpoint inhibitor-induced neurotoxicity.

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

Cited by 23 publications

References 22 publications

Immune checkpoint inhibitors‐induced neuromuscular toxicity: From pathogenesis to treatment

Immune checkpoint inhibitors‐induced neuromuscular toxicity: From pathogenesis to treatment

Detect it so you can treat it: a case series and proposed checklist to detect neurotoxicity in checkpoint therapy

Detect it so you can treat it: A case series and proposed checklist to detect neurotoxicity in checkpoint therapy

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