Guillain–Barré‐like syndrome during pembrolizumab treatment

Ong, Stephanie; Chapman, J. D.; Young, Gavin; Mansy, T.

doi:10.1002/mus.26101

Cited by 18 publications

(17 citation statements)

References 15 publications

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“…ICI-therapy induced Guillain-Barré syndrome is another severe irAE of the peripheral nervous system. Reflecting upon the characteristics of published case reports (Table S2), it becomes obvious that clinical presentation, course, and electrophysiological findings resemble those of not-ICI-related Guillain-Barré syndrome [40,41,42,43,44]. However, relatively frequently patients with ICI-induced Guillain-Barré syndrome exhibit an elevated CSF cell count [39,45], while classical Guillain-Barré syndrome patients usually do not show significant CSF pleocytosis [46].…”

Section: Peripheral Nervous System Complicationsmentioning

confidence: 99%

Neurological Immune Related Adverse Events Associated with Nivolumab, Ipilimumab, and Pembrolizumab Therapy—Review of the Literature and Future Outlook

Möhn

Beutel

Gutzmer

et al. 2019

JCM

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Immune checkpoint inhibitor (ICI) therapy has revolutionized the management of various cancers with previously poor prognosis. Despite its great efficacy, the therapy is associated with a wide spectrum of immune-related adverse events (irAE) including neurological symptoms which can affect all parts of the central and peripheral nervous system. Even though these events are rare, they are of high relevance as the rate of residual symptoms or even fatal outcomes is remarkable. To provide a detailed overview of neurological adverse events associated with immune checkpoint-inhibitor therapy we conducted a literature search. While focusing on ipilimumab, nivolumab, and pembrolizumab therapy, all available case reports as well as larger case series and clinical trials have been considered. Eighty-two case reports about checkpoint-inhibitor therapy induced symptoms of the peripheral nervous system have been published, while only 43 case reports addressed central nervous system abnormalities. The frequency of immune checkpoint-inhibitor therapy inducing neurological adverse events is about 1% in larger studies. Especially neuromuscular adverse events exhibit distinct clinical and diagnostic characteristics. Additionally, several affected patients presented with overlap-syndromes, which means that symptoms and diagnostic findings indicating myositis, myasthenia gravis, and neuropathy were present in one individual patient at the same time. Thus, neurological and particularly neuromuscular adverse events of immune checkpoint-inhibitor therapy may constitute a new disease entity.

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Section: Peripheral Nervous System Complicationsmentioning

confidence: 99%

Neurological Immune Related Adverse Events Associated with Nivolumab, Ipilimumab, and Pembrolizumab Therapy—Review of the Literature and Future Outlook

Möhn

Beutel

Gutzmer

et al. 2019

JCM

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“…A variety of irAEs have been attributed to ICI therapy: dermatologic reactions, colitis, hepatitis, endocrinopathies, pneumonitis, and rheumatologic complications ( Han et al, 2020 , Kao et al, 2018 ). Several case reports and case series detail neurologic adverse events of ICI use in other cancers, most commonly melanoma and lung cancer, but also renal cell carcinoma, glioblastoma, and Hodgkin lymphoma ( Han et al, 2020 , Fellner et al, 2018 , Ong et al, 2018 ).…”

Section: Discussionmentioning

confidence: 99%

“…The complementary role of these pathways is in preventing autoimmunity. This mechanism is hypothesized to reduce peripheral tolerance of self-antigens, promoting cross-reactivity through molecular mimicry by tumor cells and resulting in autoimmune events ( Fellner et al, 2018 , Ong et al, 2018 , Psimaras et al, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

Guillain-Barre Syndrome in a patient with uterine adenocarcinoma undergoing treatment with immune-checkpoint inhibitor therapy: A case report and review of the literature

Brzezinska

Higgins

Rungruang

2021

Gynecologic Oncology Reports

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“…The literature on checkpoint inhibitor-induced GBS is limited, as only a small number of cases have been reported, summarized in Table 1. Both CTLA-4 and PD-1 inhibitors have been implicated [3, 5, 14–20, 23–27]. Multiple GBS variants have been described, including classic AIDP, enteric neuropathy, and pandysautonomia [3, 5, 14–20].…”

Section: Discussionmentioning

confidence: 99%

“…Less commonly, hepatic, pulmonary, adrenal, cardiovascular, renal, pancreatic, and neurologic toxicities have been reported [6, 8–13]. Guillain-Barré syndrome (GBS) is a particularly rare neurologic irAE, with only a handful of cases reported in the literature, often with varying clinical features [3, 5, 14–20].…”

Section: Introductionmentioning

confidence: 99%

Safe Transition to Pembrolizumab following Ipilimumab-Induced Guillain-Barré Syndrome: A Case Report and Review of the Literature

Gravbrot

Scherer

Sundararajan

2019

Case Reports in Oncological Medicine

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Background Immune checkpoint inhibitors are novel therapies with indications for treating several solid cancers. They are associated with immune-related adverse events, which are generally well tolerated. Though rare, severe side effects may be life-threatening. One such adverse event is Guillain-Barré syndrome, which requires cessation of the immunotherapy and intravenous immunoglobulin and/or high-dose steroids to treat. No recommendations have been published regarding restarting cancer treatment after development of immunotherapy-induced Guillain-Barré syndrome. Case Presentation A 71-year-old gentleman with recurrent, stage IIIB melanoma was started on ipilimumab (cytotoxic T lymphocyte antigen-4 inhibitor) for adjuvant treatment following radical neck dissection and radiation therapy. After completing his third cycle of ipilimumab, he developed rapidly progressive ascending paralysis. He was diagnosed with ipilimumab-induced atypical Guillain-Barré syndrome and was treated with intravenous immunoglobulin and corticosteroids. Ipilimumab was discontinued, and the patient was monitored via surveillance imaging, as there was no evidence of active disease at that time. Several months later, he was found to have recurrent disease involving the lung, requiring right lower lobectomy. Restaging revealed thoracic lymph node involvement, and he was then started on pembrolizumab (programmed cell death protein-1 inhibitor). He experienced a complete tumoral response to pembrolizumab, and he tolerated treatment well without recurrent weakness. Conclusions Guillain-Barré syndrome is a rare but severe complication associated with immunotherapy. Our findings suggest that in patients with a history of ipilimumab-induced Guillain-Barré syndrome, pembrolizumab may possibly be a safe and effective alternative for cancer therapy.

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Guillain–Barré‐like syndrome during pembrolizumab treatment

Cited by 18 publications

References 15 publications

Neurological Immune Related Adverse Events Associated with Nivolumab, Ipilimumab, and Pembrolizumab Therapy—Review of the Literature and Future Outlook

Neurological Immune Related Adverse Events Associated with Nivolumab, Ipilimumab, and Pembrolizumab Therapy—Review of the Literature and Future Outlook

Guillain-Barre Syndrome in a patient with uterine adenocarcinoma undergoing treatment with immune-checkpoint inhibitor therapy: A case report and review of the literature

Safe Transition to Pembrolizumab following Ipilimumab-Induced Guillain-Barré Syndrome: A Case Report and Review of the Literature

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