Fatal enteric plexus neuropathy after one dose of ipilimumab plus nivolumab: a case report

Appelbaum, Jacob; Wells, Dilys; Hiatt, Joseph; Steinbach, Gideon; Stewart, F. Marc; Thomas, Hannah; Nghiem, Paul; Kapur, Raj P.; Thompson, John A.; Bhatia, Shailender

doi:10.1186/s40425-018-0396-9

Cited by 37 publications

(35 citation statements)

References 42 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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“…These effects were referred to as immune-related adverse effects (irAEs) [5–10]. The frequency and severity of irAEs are even greater inpatients undergoing combined ICIs therapy [11–16]. Here, we report a case of fatal myositis complicated with spontaneous haematoma of the skeletal muscle after administration of Opdivo and Yervoy, which we hope will remind physicians to monitor the side effects and use these medications more discreetly.…”

Section: Introductionmentioning

confidence: 99%

Fatal myositis and spontaneous haematoma induced by combined immune checkpoint inhibitor treatment in a patient with pancreatic adenocarcinoma

Liu

Zhang

et al. 2019

BMC Cancer

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BackgroundImmune checkpoint inhibitors (ICIs) have achieved unprecedented success in cancer treatment over the past decade. The application of ICIs hasled to the discovery of various types of immune-related adverse events (irAEs). Here, we report a case of fatal myositis and spontaneous haematoma following concurrent treatment of nivolumab and ipilimumab for pancreatic adenocarcinoma.Case presentationA 71-year-old gentleman with pancreatic adenocarcinoma underwent the Whipple procedure in September 2014. The patient received 8 cycles of adjuvant chemotherapy with gemcitabineand achieved a complete responsein April 2015. Treatment with the PD-1 inhibitor nivolumab was started due to suspected tumour recurrence in November 2015. In August 2016, the CTLA-4 inhibitor ipilimumab was added to nivolumab for 2 cycles. Eight weeks after the last dose, the patient developed severe myositis complicated with spontaneous haematomain skeletalmuscle. Pathology of the skeletal muscle autopsy revealed lymphocytic infiltration. Intense immunosuppressive therapy, including high-dose corticosteroids and methotrexate, resulted in clinical success in the treatment of myositis. However, the patient died of cancer recurrence.ConclusionMyositis due to immunotherapy can be a fatal adverse event of ICIs, which requires close monitoring and cautious management.

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“…Hemorrhagic gastritis has been reported with PD‐1 blockade in the absence of other luminal inflammation . In addition, disorders of GI motility have been reported as rare manifestations of neurologic toxicity from checkpoint blockade .…”

Section: Rare Luminal Gi 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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Fatal enteric plexus neuropathy after one dose of ipilimumab plus nivolumab: a case report

Cited by 37 publications

References 42 publications

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

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

Fatal myositis and spontaneous haematoma induced by combined immune checkpoint inhibitor treatment in a patient with pancreatic adenocarcinoma

Diagnosis and Management of Rare Immune-Related Adverse Events

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