Safe Transition to Pembrolizumab following Ipilimumab-Induced Guillain-Barré Syndrome: A Case Report and Review of the Literature

Gravbrot, Nicholas; Scherer, Katalin; Sundararajan, Srinath

doi:10.1155/2019/5490707

Cited by 6 publications

(7 citation statements)

References 30 publications

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“…Of these, four patients received nivolumab in combination with ipilimumab, and one patient received nivolumab in combination with pembrolizumab. In the above cases, the types of tumor the patients suffered from were melanoma ( n = 20) [ 13 , 14 , 16 , 17 , 23 , 24 , 28 , 29 , 31 – 37 , 39 – 42 ], lung tumor ( n = 7) [ 18 , 21 , 25 , 26 , 28 , 30 , 38 ], urinary tumor ( n = 5) [ 13 , 15 , 19 , 20 , 22 ], and nasal cancer ( n = 1) [ 27 ]. The details were summarized in Tables 4 and 5 .…”

Section: Resultsmentioning

confidence: 99%

“…54.5% (18/33) of cases were consistent with AIDP [ 16 – 19 , 21 , 22 , 24 , 26 – 30 , 33 , 34 , 39 , 42 ] and axonal damage accounted for 12.1% (4/33, AMSAN: 3 and AMAN: 1) [ 15 , 23 , 25 , 27 ]. The subtypes in four cases were equivocal because they showed mixed features of axonal injury and demyelination [ 23 , 31 , 35 , 36 ]. There were also three cases, two with MFS [ 13 , 20 ] and the other with MFS-GBS overlap [ 32 ].…”

Section: Resultsmentioning

confidence: 99%

“…Slight pleocytosis (i.e., cell count > 5/ μ l) was detected in 4/33 cases (12.1%) with a maximum cell count of 15/ μ l and a median CSF protein of 115 mg/dl [ 15 , 19 , 27 , 37 ]. CSF protein values and cell counts were normal in three cases [ 23 , 25 , 35 ], and there was elevated CSF immunoglobulin G levels in one case [ 25 ].…”

Section: Resultsmentioning

confidence: 99%

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Guillain-Barré Syndrome-Like Polyneuropathy Associated with Immune Checkpoint Inhibitors: A Systematic Review of 33 Cases

Zhang

Zhao

2021

BioMed Research International

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Immune checkpoint inhibitors (ICIs) have been increasingly used in the treatment of various types of tumors with favorable results. But these treatments also led to a variety of immune-related adverse events (irAEs). Neurological irAEs such as Guillain-Barré Syndrome are rare and may have serious consequences once they occur. A systematic literature search was performed in PubMed and Embase for all case reports of GBS associated with ICIs published in English reporting on human beings from 1990 up to date. A total of 30 case reports ( total patients = 33 ) were used for final analysis. The included cases were from 11 countries, covering 10 tumor types, with melanoma accounting for the largest number. The mean age was 62.2 ± 11.1 years old, and males were dominant (male: 26 and female: 7). The median time of initial symptoms was 8.2 weeks after the 1st dose of ICIs. The most common manifestations of GBS associated with ICIs were weakness, hyporeflexia or areflexia, and paresthesia in order. The GBS subtypes suggested by electrophysiological results were acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN), and Miller Fisher syndrome (MFS). The protein level of CSF in patients with GBS related to ICIs was 180.68 ± 152.51 mg/dl. Immediate termination of ICIs followed by intravenous immunoglobulin was the preferred treatment option. 72.7% of patients recovered or had residual mild dysfunction after treatment. Elderly male patients with melanoma were most likely to develop ICI-related GBS. The specific neurological symptoms, CSF analysis, and electrophysiological examination were important means of diagnosis.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Guillain-Barré Syndrome-Like Polyneuropathy Associated with Immune Checkpoint Inhibitors: A Systematic Review of 33 Cases

Zhang

Zhao

2021

BioMed Research International

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“…33,34,39 Nevertheless, 2 cases in the literature describe a safe ICI rechallenge with a different class of ICI after ICI-related GBS. 12,17 We believe reintroduction of ICI therapy after ICI-related GBS should only be considered after the approval of a multidisciplinary irAE team.…”

Section: Discussionmentioning

confidence: 99%

Immune Checkpoint Inhibitor–related Guillain-Barré Syndrome: A Case Series and Review of the Literature

Janssen¹,

Leow²,

Herbschleb

et al. 2021

Journal of Immunotherapy

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Immune checkpoint inhibitors (ICIs) have been approved for the treatment of various malignancies with promising clinical outcomes. Treatment can, however, be accompanied by serious immune-related adverse events. Neurological adverse events like Guillain-Barré syndrome (GBS) are rare but potentially lifethreatening. We present 3 cases of ICI-related GBS; review cases described in current literature, and discuss treatment strategies. Three patients developed GBS after ICI treatment. The first case with pembrolizumab had a fatal outcome despite treatment with multiple regimens, including steroids and intravenous immunoglobulin (IVIg). The other 2 cases with nivolumab-induced and pembrolizumab-induced GBS, respectively, responded well to treatment with IVIg and steroids. In the current literature, a total of 31 other cases were found. Treatment for ICI-related GBS mostly consisted of concurrent IVIg and steroids (44%), which led to clinical improvement in 73%. Most patients recovered with remaining symptoms (68%), while 10 patients developed respiratory failure (29%) and 6 patients (18%) died. ICI-related GBS should be suspected in patients on ICI treatment who develop subacute progressive weakness of the limbs, sensory loss, and areflexia. On the basis of the guidelines recommendations and our review of the literature, we advise first-line therapy with concurrent IVIg 0.4 g/kg/d for 5 days and prednisolone 1-2 mg/kg/d. Discontinuation of immunotherapy after ICI-related GBS is advised.

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“…The link between checkpoint inhibitors and the development of GBS has been described in case reports 6–11. Conversely, there have been reports highlighting the safety of ICI administration in patients with a history of GBS 12–14…”

Section: Introductionmentioning

confidence: 99%

Guillain-Barré syndrome and checkpoint inhibitor therapy: insights from pharmacovigilance data

Abrahao,

Tenório,

Rodrigues

et al. 2024

BMJ Neurol Open

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BackgroundThere are increasing reports of cases of Guillain-Barré syndrome (GBS), as an adverse event of an immune checkpoint inhibitor (ICI) but postmarket data on the incidence of this remains scarce. This study sought to conduct a comprehensive review of GBS events arising as a secondary outcome of ICI treatments in real-world patients, using the Food and Drug Administration Adverse Event Reporting System (FAERS).MethodsData covering the period from the third quarter of 2003 to the second quarter of 2023 were extracted from the FAERS database. GBS cases (associated with the usage of avelumab, atezolizumab, ipilimumab, nivolumab and pembrolizumab) were subjected to disproportionality analysis to detect potential signals.ResultsA total of 2208 reports of GBS were identified within the FAERS database, with 242 of these cases (10.9%) being associated with ICIs. All five drugs exhibited a disproportionality in the reporting of adverse events, with the highest observed for avelumab (reporting OR, ROR: 29.8), followed by atezolizumab (ROR: 17.0), ipilimumab (ROR: 16.0), pembrolizumab (ROR: 11.9) and nivolumab (ROR: 8.2).ConclusionThese checkpoint inhibitors are associated with a statistically significant disproportionate number of reports of GBS as an adverse event, with avelumab being the ICI with the highest association. The present pharmacovigilance study serves as a valuable tool, offering a more comprehensive and nuanced perspective on GBS associated with ICIs. This study contributes to a deeper comprehension of this rare adverse drug effect.

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Safe Transition to Pembrolizumab following Ipilimumab-Induced Guillain-Barré Syndrome: A Case Report and Review of the Literature

Cited by 6 publications

References 30 publications

Guillain-Barré Syndrome-Like Polyneuropathy Associated with Immune Checkpoint Inhibitors: A Systematic Review of 33 Cases

Guillain-Barré Syndrome-Like Polyneuropathy Associated with Immune Checkpoint Inhibitors: A Systematic Review of 33 Cases

Immune Checkpoint Inhibitor–related Guillain-Barré Syndrome: A Case Series and Review of the Literature

Guillain-Barré syndrome and checkpoint inhibitor therapy: insights from pharmacovigilance data

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