Pembrolizumab-Induced Demyelinating Polyradiculoneuropathy

Guillain–Barré‐like syndrome during pembrolizumab treatment

“…Since the recent approval of five PD‐1/PD‐L1 immune checkpoint inhibitors, numerous other irAEs have been described, including 2 cases of Guillain‐Barré‐like syndrome associated with pembrolizumab. One patient, a 45‐year‐old woman treated for inoperable melanoma, presented with limb paresthesia and weakness and facial paralysis . She responded well to treatment with prednisone and IVIG.…”

“…There is no high‐quality evidence regarding the optimum treatment of pembrolizumab‐induced neurological irAEs; however, guidelines, based on clinical trial experience and expert consensus, have been formulated by the manufacturers in collaboration with the US Food and Drug Administration. The suggested mainstay of treatment, for moderate or severe manifestations, is to withhold or discontinue immunotherapy and consider steroid treatment . Although most irAEs are reversible with steroids, there is concern that immunosuppression may compromise the antitumor response.…”

“…For this reason, it is recommended that high‐dose steroids should be used for a short period of time and then gradually reduced in dose and withdrawn . Adjunctive IVIG and plasmapheresis have been used with varying success, and it has been suggested that these should be considered in severe cases . Early recognition and supportive care is essential because cases of death due to neuromuscular respiratory complications have been reported …”

Demyelinating polyradiculoneuropathy under combined BRAF/MEK inhibitors

“…In only one case, AIDP occurred with vemurafenib, preceded by a generalized rash similarly to the case presented [1]. Demyelinating polyradiculoneuropathy has also been described with immune checkpoint inhibitor agents that restore antitumour immunity [2,3]. Since demyelinating polyradiculoneuropathy has also been reported in patients suffering from melanoma, the causal role of immune checkpoint inhibitors and vemurafenibecobimetinib might be challenging to establish [4].…”

History and current state of immunotherapy in glioma and brain metastasis

“…There are multiple reports of autoimmune neurologic side effects of checkpoint inhibitors including hypophysitis, encephalitis, demyelinating polyneuropathy and encephalomyelitis. 128–135 These can often be completely reversible, particularly if recognized and treated early, however several deaths secondary to autoimmune toxicity have been reported. There have also been two case reports, one with melanoma and the other with NSCLC, who 1–2 months after treatment with PD-1 inhibitors had biopsy-confirmed delayed radiation-induced vasculitic leukoencephalopathy.…”