Neurologic immune-related adverse events associated with adjuvant ipilimumab: report of two cases

Journal for Immunotherapy of Cancer
Christine A GarciaDiwakar Davar

Abstract

PD-1 and CTLA-4 inhibitors are associated with several adverse events including a spectrum of immune-related adverse effects (irAEs). Neurologic irAEs are uncommon occurrences with varied presentations. We describe two separate cases of ipilimumab associated meningoencephalomyelitis and demyelinating polyneuropathy with unusual presentations. Two melanoma patients were treated with ipilimumab in the adjuvant setting. The first patient developed a meningoencephalitis following 3 doses of ipilimumab. MRI imaging of the brain confirmed leptomeningeal enhancement although cerebrospinal fluid (CSF) analyses were negative for malignant cells consistent with meningoencephalomyelitis. Although she initially improved following treatment with steroids and intravenous immunoglobulin, she subsequently relapsed. She was successfully treated with infliximab and made a complete neurological recovery. A second patient developed progressive lower extremity weakness following two doses of ipilimumab. MRI imaging of the spine confirmed diffuse nerve root enhancement consistent with acute inflammatory demyelinating polyneuropathy (AIDP). He was treated with high dose steroids with resolution of neurological symptoms. Both patients remain disease f...Continue Reading

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Citations

Mar 15, 2020·Journal for Immunotherapy of Cancer·Daniel J OlsonThomas F Gajewski
Jun 21, 2019·Journal of Experimental & Clinical Cancer Research : CR·Stephan KrugerMichael von Bergwelt-Baildon
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Methods Mentioned

BETA
biopsy
dissection

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