Nivolumab-Induced Autoimmune Encephalitis in Two Patients with Lung Adenocarcinoma

Abstract

Immune checkpoint inhibitors have improved patient survival outcomes in a variety of advanced malignancies. However, they can cause a number of immune-related adverse effects (irAEs) through lymphocyte dysregulation. Central nervous system (CNS) irAEs are rare, but as the number of indications for checkpoint inhibitors increases, there has been emergence of CNS immune-mediated disease among cancer patients. Given the relatively recent recognition of checkpoint inhibitor CNS irAEs, there is no standard treatment, and prognosis is variable. Therefore, there is a great need for further study of checkpoint inhibitor-induced CNS irAEs. Here, we present two unique cases of nivolumab-induced autoimmune encephalitis in patients with non-small cell lung cancer and review the available literature.

Atezolizumab-induced encephalitis in metastatic lung cancer: a case report and literature review

“…In cases of atezolizumab-induced encephalitis, corticosteroid treatment alone improved the symptoms and no additional immunological treatment was required. In some cases of encephalitis induced by nivolumab as used as a PD-1 inhibitor, corticosteroid treatment was followed by immunoglobulin or plasma exchange [6,7]. In our case, improvements in clinical symptoms and laboratory values were observed following treatment with corticosteroids.…”

Glioma associated microglia/macrophages, a potential pharmacological target to promote antitumor inflammatory immune response in the treatment of glioblastoma

“…The most common side effects involve the skin, colon, endocrine organs and liver. Rarely, neurological complications have been described [41] , including recent case reports on nivolumab-induced autoimmune encephalitis [42] and progressive multifocal leukoencephalopathy [43] .…”

Autoimmune encephalitis associated with Ma2 antibodies and immune checkpoint inhibitor therapy

“…Anti-Ma2 antibodies are usually associated with testicular tumours but may occur with other malignancies, particularly non-small cell lung cancers 5. The median age when patients are affected is 64 (53–82) years, with neurological symptoms often preceding the cancer diagnosis (62% in one important case series) 6…”