Natalizumab may control immune checkpoint inhibitor–induced limbic encephalitis

Hottinger, Andreas F.; Micheli, Rita De; Guido, Vanessa; Karampera, Alexandra; Hagmann, Patric; Pasquier, Renaud Du

doi:10.1212/nxi.0000000000000439

Cited by 82 publications

(74 citation statements)

References 13 publications

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“…Other studies have reported detection of Ma2 IgG (n = 6) among CNS irAE with variable cancer subtypes, not compatible with typical oncological association (germ cell tumors) of Ma2 IgG . As indications for cancer immunotherapies grow, cases of classic paraneoplastic phenotypes are also reported; for example, limbic encephalitis in association with anti‐Hu, antineuronal nuclear antibody type‐1, and Lambert–Eaton myasthenia syndrome in association with P/Q type voltage gated calcium channel antibodies . It is possible that the proportion of cases with classic paraneoplastic phenotypes in association with specific malignancies such as small cell cancer may become more apparent .…”

Section: Atypical Overlapping Spectrum Of Irae‐nmentioning

confidence: 98%

Severe Neurological Toxicity of Immune Checkpoint Inhibitors: Growing Spectrum

Dubey

David

Reynolds

et al. 2020

Annals of Neurology

164

189

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Expanding use of immune-checkpoint inhibitors (ICIs) underscores the importance of accurate diagnosis and timely management of neurological immune-related adverse events (irAE-N). We evaluate the real-world frequency, phenotypes, co-occurring immune-related adverse events (irAEs), and long-term outcomes of severe, grade III to V irAE-N at a tertiary care center over 6 years. We analyze how our experience supports published literature and professional society guidelines. We also discuss these data with regard to common clinical scenarios, such as combination therapy, ICI rechallenge and risk of relapse of irAE-N, and corticosteroid taper, which are not specifically addressed by current guidelines and/or have limited data. Recommendations for management and future irAE-N reporting are outlined.

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Section: Atypical Overlapping Spectrum Of Irae‐nmentioning

confidence: 98%

Severe Neurological Toxicity of Immune Checkpoint Inhibitors: Growing Spectrum

Dubey

David

Reynolds

et al. 2020

Annals of Neurology

164

189

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“…Case reports have been published describing the successful use of plasmapheresis and intravenous immunoglobulin in patients with neurologic irAEs. Natalizumab, an α4‐integrin antibody approved for the treatment of multiple sclerosis, has been used to treat a patient who developed autoimmune encephalitis with anti‐Hu antibodies after treatment with ipilimumab‐nivolumab …”

Section: Checkpoint Inhibitorsmentioning

confidence: 99%

“…Natalizumab, an α4-integrin antibody approved for the treatment of multiple sclerosis, has been used to treat a patient who developed autoimmune encephalitis with anti-Hu antibodies after treatment with ipilimumab-nivolumab. 88…”

Section: Rare Immune-related Adverse Eventsmentioning

confidence: 99%

A review of cancer immunotherapy toxicity

Kennedy

Salama

2020

CA A Cancer J Clinicians

926

699

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Cancer immunotherapies, including checkpoint inhibitors and adoptive cell therapy, manipulate the immune system to recognize and attack cancer cells. These therapies have the potential to induce durable responses in multiple solid and hematologic malignancies and thus have transformed treatment algorithms for numerous tumor types. Cancer immunotherapies lead to unique toxicity profiles distinct from the toxicities of other cancer therapies, depending on their mechanism of action. These toxicities often require specific management, which can include steroids and immune‐modulating therapy and for which consensus guidelines have been published. This review will focus on the toxicities of checkpoint inhibitors and chimeric antigen receptor T cells, including pathophysiology, diagnosis, and management.

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“…It has also been used in a relapsing case of limbic encephalitis in a patient with stage IV SCLC, leading to cognitive improvement without impairing a durable tumor response with a combined checkpoint inhibition. 51 Vedolizumab is an anti-integrin α4β7 antibody showing in gut-selective anti-inflammatory activity, with indication for the treatment of refractory IBD. Its efficacy has been reported in a case-series of seven steroidrefractory cases of ICI-induced colitis, obtaining a remission in six patients.…”

Section: Anti-integrinmentioning

confidence: 99%

New therapeutic perspectives to manage refractory immune checkpoint-related toxicities

Martins

Sykiotis

Maillard

et al. 2019

The Lancet Oncology

155

153

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Immune-checkpoint inhibitors (ICIs) are reshaping the prognosis of many cancer types and are progressively becoming a standard of care for many of them. Cancer immunotherapy has started a revolution in the oncology therapeutic landscape, bringing new hope to patients but also a whole new spectrum of toxicities for practitioners to manage. Oncologists and specialists involved in the pluridisciplinary management of immune-related adverse events (irAEs) are increasingly confronted with the therapeutic challenge of severe and/or refractory cases. In this personal view, we summarize the therapeutic strategies reported to manage them. Based on current knowledge of irAE pathogenesis and our immunological expertise, we also transpose the use of new biologic and non-biologic immunosuppressive agents, used to treat primary autoimmune disorders (AIDs), in the context of severe and/or steroid refractory irAE management. Depending on the immune-type predominant infiltrate, we propose a personalized treatment algorithm beyond corticosteroids. A shut-off strategy, intended to treat severe or steroid-refractory irAEs, based on the efficient inhibition of key inflammatory components involved in their pathophysiological processes, and limit potential adverse effects of drug immunosuppression on tumor response is proposed. This approach goes beyond current guidelines, challenging the step-by-step increase in drug immunosuppression proposed so far.

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Natalizumab may control immune checkpoint inhibitor–induced limbic encephalitis

Cited by 82 publications

References 13 publications

Severe Neurological Toxicity of Immune Checkpoint Inhibitors: Growing Spectrum

Severe Neurological Toxicity of Immune Checkpoint Inhibitors: Growing Spectrum

A review of cancer immunotherapy toxicity

New therapeutic perspectives to manage refractory immune checkpoint-related toxicities

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