Case Report: Encephalitis, with Brainstem Involvement, Following Checkpoint Inhibitor Therapy in Metastatic Melanoma

Bossart, Simon; Thurneysen, S.; Frontzek, Karl; Leske, Henning; Mihic‐Probst, Daniela; Nagel, Hannes W.; Mangana, Johanna; Goldinger, Simone M.

doi:10.1634/theoncologist.2016-0366

Cited by 36 publications

(34 citation statements)

References 23 publications

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“…Pathological examination does not usually reveal any definitive results. According to previous reports, the encephalitis caused by irAEs may be shown as extensive demyelination, edema and necrosis, or evidence of lymphocytic infiltration around blood vessels and brain parenchyma …”

Section: Adverse Central Nervous System Reactions To Icismentioning

confidence: 95%

“…immune‐mediated encephalitis usually occurs 55 days (18–297 days) after treatment with ICIs. Approximately 0.2% of the patients receiving PD‐1 treatment developed immune‐mediated encephalitis, including marginal lobe encephalitis, brainstem encephalitis and necrotizing encephalitis . The clinical manifestations of immune‐mediated encephalitis are nonspecific but the main symptoms are headache, fever, mental disorder, memory disorder, drowsiness, hallucination, seizure, neck stiffness, mental state decline, attention impairment and disorientation .…”

Section: Adverse Central Nervous System Reactions To Icismentioning

confidence: 99%

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Clinical diagnosis and treatment recommendations for immune checkpoint inhibitor‐related adverse reactions in the nervous system

et al. 2019

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Immune checkpoint inhibitors (ICIs) can cause adverse reactions in the nervous system. The incidence rate is 0.1%-12% and 80% of nervous system adverse reactions occur within the first four months of application. ICIs can cause diseases of various parts of the nervous system including central nervous system diseases such as aseptic meningitis, meningeal encephalitis, necrotizing encephalitis, brainstem encephalitis, transverse myelitis, etc., and peripheral neuropathy such as cranial nerve peripheral neuropathy, multifocal nerve root neuropathy, Guillain-Barré syndrome, spinal nerve root neuropathy, myasthenia gravis, myopathy, etc. For these complications of the nervous system, diagnosis could be difficult. Physicians require a specific collection of nervous system symptoms and signs, combined with supplementary examinations including imaging, cerebrospinal fluid cytology, EEG or electromyography in order to exclude infection or malignant tumor before reaching a final diagnosis. With regard to treatment, ICIs should be discontinued in severe cases, and large doses of glucocorticoid or gamma globulin administered, and supportive treatment may be necessary. If severe adverse reactions of the nervous system occur, the prognosis could be poor.

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Section: Adverse Central Nervous System Reactions To Icismentioning

confidence: 95%

Section: Adverse Central Nervous System Reactions To Icismentioning

confidence: 99%

Clinical diagnosis and treatment recommendations for immune checkpoint inhibitor‐related adverse reactions in the nervous system

et al. 2019

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“…A broad range of autoimmune toxicities have been reported, and nearly all organs can be affected, including skin, gastrointestinal tract, lung, kidney and heart, among others (Michot et al 2016). Even immune-privileged organs such as the eye and the brain can be affected (Crews et al 2015, Henderson et al 2015, Yeh et al 2015, Bossart et al 2017. The incidence of any grade irAEs is reported to range from 15 to 90% in single agent trials (Hodi et al 2010, Eggermont et al 2016, Ferris et al 2016, Kumar et al 2017.…”

Section: Introductionmentioning

confidence: 99%

Endocrine side effects of cancer immunotherapy

Cukier¹,

Santini²,

Scaranti³

et al. 2017

Endocrine-Related Cancer

140

114

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Immune checkpoint inhibitors have recently become a cornerstone for the treatment of different advanced cancers. These drugs, represented mainly by monoclonal antibodies anti-cytotoxic T-lymphocyte antigen 4 (CTLA-4), anti-programmed cell death protein-1 (PD-1) and anti-PD-1 ligand molecules (PD-L1 and L2), have the ability to reactivate the immune system against tumor cells, but can also trigger a myriad of autoimmune side effects, termed immune-related adverse events (irAEs). In particular, there are a number of endocrine-related irAEs. Current data from clinical trials show increased incidence of hypophysitis with CTLA4 inhibition and thyroid dysfunction with PD-(L)1 blockade. In addition, a few cases of type 1 diabetes mellitus and primary adrenal insufficiency have been reported. We discuss the incidence, clinical manifestations, diagnosis and management of immune-related endocrinopathies in this highly complex context of oncological patients in need of immunotherapies.

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“…Adverse events typically affect the skin, gastrointestinal, hepatic, and endocrine systems 10 . While symptoms of adverse events can usually be managed, permanent sequelae and even fatalities have occurred 11,12 …”

Section: Introductionmentioning

confidence: 99%

Therapy preferences in melanoma treatment—Willingness to pay and preference of quality versus length of life of patients, physicians, healthy individuals and physicians with oncological disease

2020

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Background In recent years, monoclonal antibodies such as ipilimumab, nivolumab, and pembrolizumab have made a significant impact on the treatment of advanced melanoma. Combination of immune checkpoint inhibitors leads to improved survival and response rates of 58%‐61% as compared to monotherapy (36%‐44%). However, the price for the better response rates is also a higher frequency of severe adverse events (59%) as compared to monotherapy (17%‐21%). This study examines attitudes towards melanoma therapy options of physicians, healthy individuals, melanoma patients, and physicians with oncological disease, their willingness to pay, and preference of quality versus length of life. Methods After obtaining ethical approval and informed consent surveys were conducted in 111 participants divided into four groups: melanoma patients (n = 30), healthy individuals as controls (n = 30), physicians (n = 27), and physicians with oncological disease (n = 24). Statistical analyses were conducted using SPSS statistics (version 25, IBM), applying the Pearson´s chi‐squared test, Spearman correlation coefficient, Wilcoxon‐Mann‐Whitney test, and Kruskal‐Wallis test. Results Life prolongation is more valued by melanoma patients and physicians with oncological disease compared to healthy controls and healthy physicians. In total, 30% of melanoma patients opt for a life prolonging therapy in all cases, even if this life prolongation is only marginal. Physicians are the strongest proponents of combination immunotherapy. Conclusion The valuation of the different treatment options differs in the four study groups with affected people valuing life prolongation much more. The individual value of cancer therapies is high, but differs from the societal standpoint.

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Case Report: Encephalitis, with Brainstem Involvement, Following Checkpoint Inhibitor Therapy in Metastatic Melanoma

Cited by 36 publications

References 23 publications

Clinical diagnosis and treatment recommendations for immune checkpoint inhibitor‐related adverse reactions in the nervous system

Clinical diagnosis and treatment recommendations for immune checkpoint inhibitor‐related adverse reactions in the nervous system

Endocrine side effects of cancer immunotherapy

Therapy preferences in melanoma treatment—Willingness to pay and preference of quality versus length of life of patients, physicians, healthy individuals and physicians with oncological disease

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