Unilateral autoimmune inner ear disease in a patient with lung cancer treated with nivolumab

Abstract

A 69-year-old male presented with early stage non-small cell lung cancer in 2016. The tumor was resected; however, the patient experienced recurrence 2 years later and subsequently received paclitaxel/carboplatin concurrently with radiotherapy. Within weeks of completing this treatment, he developed a symptomatic pancoast tumor secondary to disease progression and commenced second line nivolumab. Following the second dose of nivolumab, he developed acute unilateral right hearing loss. He commenced intravenous methylprednisolone followed by a slow taper of oral prednisolone. With steroids, he noted a gradual improvement in hearing, confirmed by audiology. Restaging imaging post-nivolumab demonstrated a complete metabolic response. Two prior cases have reported bilateral sensorineural hearing loss post-immune checkpoint inhibitor (ICI). We postulate the hearing impairment relates to the development of autoimmune inner ear disease. To our knowledge, this is the only case of a patient experiencing unilateral loss of hearing following an ICI.

Pharmacotherapy of cerebellar and vestibular disorders

“…Autoimmune inner ear disease (AIED) is characterized by idiopathic, progressive, bilateral, asymmetric and subacute sensorineural hearing loss, accompanied or not by vestibular impairment, which responds to immunomodulatory drugs [42]. Oral steroids, followed or not by intratympanic administration, constitute the treatment of choice for AIED, and have been associated with audiologic improvement in up to 70% of patients.…”

“…For refractory disease and/or steroid-related adverse effects, steroid-sparing agents have been used (e.g., methotrexate). Emerging treatment options for AIED include biologic agents which target tumor necrosis factor (TNF)a (e.g., infliximab, adalimumab, golimubab, and etanercept), B-cells (e.g., rituximab) or interleukin (IL)-1beta (e.g., anakinra) [42]. Elevated plasma levels of interleukin (IL)-…”

“…Elevated plasma levels of interleukin (IL)-6 and IL-1 seem to signal corticosteroid-resistant patients [43 ▪ ]. The use of immune checkpoint inhibitors has also been associated with AIED [44 ▪ ].…”