Neurofilament light chain levels reflect outcome in a patient with glutamic acid decarboxylase 65 antibody–positive autoimmune encephalitis under immune checkpoint inhibitor therapy

Piepgras, Johannes; Müller, Aneka; Steffen, Falk; Lotz, Johannes; Loquai, Carmen; Zipp, Frauke; Dresel, Christian; Bittner, Stefan

doi:10.1111/ene.14692

Cited by 9 publications

(6 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Six patients suspended ICI immediately after the onset of AE symptoms. Piepgras et al reported a patient whose treatment with nivolumab was continued after controlling symptoms with steroids and infliximab but died after the encephalitis symptoms recurred [ 36 ]. In contrast to the previously reported patient, our patient had a good prognosis at the 1-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

Immune Checkpoint Inhibitor Associated Autoimmune Encephalitis, Rare and Novel Topic of Neuroimmunology: A Case Report and Review of the Literature

et al. 2022

View full text Add to dashboard Cite

Immune checkpoint inhibitors (ICIs) are being used in patients with various advanced malignancies, and patient outcomes have improved considerably. Although ICIs can effectively treat tumors, 30–60% of patients experience immune-related adverse events (irAEs). Autoimmune encephalitis (AE) is a rare irAE that has become a novel topic in neuroimmunology and has received increasing attention in recent years. Herein, we report a rare case of GAD65-antibody–associated AE after metastatic small cell lung cancer treatment with pembrolizumab. The patient received IVIg therapy for AE and continuous pembrolizumab therapy without suspension of tumor treatment. At 1 year follow-up, both the patient’s AE symptoms and tumors were stable. We consider that the treatment of ICI-associated AE should be more individualized with prudent decision-making and should balance the tumor progression and AE treatment. In addition, we have also comprehensively reviewed the literature of ICI-associated AE, and summarized the clinical features, treatment, and prognosis of AE caused by ICI, thus broadening our understanding of the neurological complications caused by ICI.

show abstract

Section: Discussionmentioning

confidence: 99%

Immune Checkpoint Inhibitor Associated Autoimmune Encephalitis, Rare and Novel Topic of Neuroimmunology: A Case Report and Review of the Literature

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Intriguingly, in contrast with previous reports [3,23], a high percentage of patients tested positive for autoantibodies, mostly to intracellular antigens. The inclusion of patients with novel reactivities such as NIF, TRIM46 [14,[19][20][21] or uncharacterized antibodies may explain this discrepancy and highlights the importance of using tissue-based assays to detect antibodies that could be missed by commercially available kits, both in patients presenting with an iRAE and in patients who will start ICI treatment [17,19].…”

Section: Discussionmentioning

confidence: 99%

“…Of these, 61 full-text articles were assessed and 27 of them fulfilled inclusion criteria. Five more records were included from other sources, and thus 32 articles reporting 46 patients were included in the qualitative synthesis ( [10][11][12][13][14][15][16][17][18][19][20][21][22] and Data S1). The detailed PRISMA flow chart of the systematic review is reported in Figure 1, whilst relevant data of the included patients are summarized in Table 1.…”

Section: Re Sultsmentioning

confidence: 99%

Cerebellar involvement associated with immune checkpoint inhibitors: A systematic review

Dinoto

Mantovani

Ferrari

et al. 2022

Euro J of Neurology

View full text Add to dashboard Cite

Background and purpose Immune checkpoint inhibitors (ICIs) targeting programmed death receptor 1 (PD‐1), cytotoxic T‐lymphocyte‐associated‐4 (CTLA‐4) and programmed cell death ligand 1 can be associated with immune‐related adverse events (iRAEs). Amongst neurological iRAEs, cerebellar involvement seems to be rare and currently lacks a proper characterization. The aim of this study was to phenotype cerebellar iRAEs. Methods A systematic review was performed according to PRISMA guidelines including reported patients with cerebellar involvement related to ICIs and with available individual data. Results After screening 2765 records, 32 studies with 46 patients were included. Median age was 63 years (20–82), and most patients were male (63.0%). Isolated cerebellitis was observed in 32.6% of cases, whilst the remaining cases had “cerebellitis plus”, mostly associated with encephalitis/encephalopathy. Associated tumors included most frequently lung cancer, melanoma and Merkel cell carcinoma. PD‐1 inhibitor was the most administered treatment (n = 29, 64.4%), whilst exposure to CTLA‐4 inhibitor was rare (n = 2, 4.5%). Magnetic resonance imaging was abnormal in 43.2% of patients and inflammatory cerebrospinal fluid findings were frequently observed. Autoantibodies were detected in 61.9% of patients and included novel reactivities. Amongst treatment strategies, the most common were steroids (n = 36) and ICI discontinuation (n = 28, 90.3%). Relapses were reported in 10% of patients. Most patients showed improvement/remission (n = 31) but, at last follow‐up, 12 had died. Isolated cerebellitis versus cerebellitis‐plus differed in terms of outcomes, whilst seropositive versus seronegative patients had distinct tumor associations. Discussion Cerebellar iRAEs are usually multifocal, have heterogeneous tumor associations, are most associated with PD‐1 inhibitor exposure and are related to autoantibodies, including novel reactivities.

show abstract

“…Emerging therapies such as antibody immunotherapy and CAR-T cells may also induce neurotoxicity, particularly autoimmune encephalitis, and the Immune Cell Associated Neurotoxicity Syndrome (ICANS), 1 week after treatment. In the case of post-immunotherapy autoimmune encephalitis, blood and CSF NfL rises and this result might be useful for tolerance monitoring (Piepgras et al, 2021 ). A very recent study reports that patients with ICANS after CAR-T therapy had elevated NfL levels (Schoeberl et al, 2022 ) and increased levels correlated with severity of the symptoms [(ICANS grade 0–1: 28.4 pg/ml (IQR, 19.2–49.7 pg/ml); ICANS grade 2–4: 60.0 pg/ml (IQR, 31.7–109.0 pg/ml); p < 0.01; Schoeberl et al, 2022 )].…”

Section: Nfl and Neurological Damagesmentioning

confidence: 99%

Neurofilaments contribution in clinic: state of the art

Delaby

Bousiges²,

Bouvier

et al. 2022

Front. Aging Neurosci.

View full text Add to dashboard Cite

Neurological biomarkers are particularly valuable to clinicians as they can be used for diagnosis, prognosis, or response to treatment. This field of neurology has evolved considerably in recent years with the improvement of analytical methods, allowing the detection of biomarkers not only in cerebrospinal fluid (CSF) but also in less invasive fluids like blood. These advances greatly facilitate the repeated quantification of biomarkers, including at asymptomatic stages of the disease. Among the various informative biomarkers of neurological disorders, neurofilaments (NfL) have proven to be of particular interest in many contexts, such as neurodegenerative diseases, traumatic brain injury, multiple sclerosis, stroke, and cancer. Here we discuss these different pathologies and the potential value of NfL assay in the management of these patients, both for diagnosis and prognosis. We also describe the added value of NfL compared to other biomarkers currently used to monitor the diseases described in this review.

show abstract

Neurofilament light chain levels reflect outcome in a patient with glutamic acid decarboxylase 65 antibody–positive autoimmune encephalitis under immune checkpoint inhibitor therapy

Cited by 9 publications

References 8 publications

Immune Checkpoint Inhibitor Associated Autoimmune Encephalitis, Rare and Novel Topic of Neuroimmunology: A Case Report and Review of the Literature

Immune Checkpoint Inhibitor Associated Autoimmune Encephalitis, Rare and Novel Topic of Neuroimmunology: A Case Report and Review of the Literature

Cerebellar involvement associated with immune checkpoint inhibitors: A systematic review

Neurofilaments contribution in clinic: state of the art

Contact Info

Product

Resources

About