Late-Onset Paraplegia after Complete Response to Two Cycles of Ipilimumab for Metastatic Melanoma

Abstract

Background: Ipilimumab has been shown to improve overall survival in patients with metastatic melanoma; however, complete responses (CRs) are uncommon. Immune-related side effects usually involve the skin or gastrointestinal tract. Neurologic events occur less frequently but are well described. Case Report: We report the case of a 58-year-old man with metastatic melanoma who commenced ipilimumab post spinal decompression and radiation. He developed a colitis post cycle 2 and ipilimumab was discontinued. Imaging, however, documented a radiological CR. 8 weeks later, he developed paraplegia and a myelitis despite an ongoing radiological CR. Steroid use resulted in some improvement radiologically, without clinical improvement. Conclusion: We report myelitis with consequent paraplegia as a potential neurological immune-related side effect of ipilimumab. We further describe a patient with a CR after 2 cycles of ipilimumab in the setting of radiation.

Management of side effects of immune checkpoint blockade by anti‐CTLA‐4 and anti‐PD‐1 antibodies in metastatic melanoma

“…Side effects can occur late, even after completion of treatment, as strikingly demonstrated by a case of new‐onset paraplegia five months after complete remission on ipilimumab therapy .…”

“…Nebenwirkungen können spät, auch nach Beendigung der Therapie noch auftreten, wie eindrücklich ein Fall einer neu entwickelten Paraplegie fünf Monate nach kompletter Remission unter Ipilimumab-Therapie zeigt [ 62 ] .…”

Fatal Necrotizing Encephalopathy after Treatment with Nivolumab for Squamous Non-Small Cell Lung Cancer: Case Report and Review of the Literature

“…While acute encephalopathy in that case resolved with steroids, clinical deficits resulting from myelopathy remained unchanged. Another case of extensive spinal cord edema, which developed after two cycles of ipilimumab for metastatic melanoma may be of relevance ( 34 ). Due to a lymphocytic pleocytosis (16 cells/μl), that case was classified as myelitis but clinical response to steroids was poor.…”

Hypothyroid ataxia complicating monoclonal antibody therapy

“…Pre-existing autoimmune diseases such as multiple sclerosis can also be exacerbated 22. Typically, these complications arise several weeks after starting the checkpoint inhibitor (pembrolizumab later than ipilimumab, 9 weeks vs 6 weeks)23; however, they can occur after stopping treatment 15…”