Chronic Inflammatory Demyelinating Polyneuropathy Induced by Immune Checkpoint Inhibitors: Case Reports

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Abstract

Neurological immune-related adverse events (irAE) are rare but potentially fatal complications associated with the use of immune checkpoint inhibitors (ICI). Recently, there has been a trend towards an increase in the incidence of these cases.

We present two case reports of demyelinating polyneuropathy in patients with skin melanoma treated with pembrolizumab or nivolumab. Unawareness of neurological irAE induced by ICI leads to delayed diagnosis and medical treatment, and this may result in persistent neurological deficit or even patients’ death. Neurological irAEs include myasthenia gravis, aseptic meningitis, encephalitis, myelitis, inflammatory demyelinating neuropathy, myositis or their combinations, etc. Considering their variability in patients treated with ICI and poor representation in publications, each case report can be of practical value.

About the authors

Olga A. Tikhonova

Immanuel Kant Baltic Federal University

Author for correspondence.
Email: offelia78@mail.ru
ORCID iD: 0000-0002-1796-0193

neurologist, functional diagnostics doctor, postgraduate student, assistant Department of Psychiatry and Neurosciences

Russian Federation, Kaliningrad

Dmitry S. Druzhinin

Yaroslavl State Medical University

Email: offelia78@mail.ru
ORCID iD: 0000-0002-6244-0867

D. Sci. (Med.), assistant, Department of nervous diseases with medical genetics and neurosurgery

Russian Federation, Yaroslavl

Evgenia S. Druzhinina

Pirogov Russian National Research Medical University

Email: offelia78@mail.ru
ORCID iD: 0000-0002-1004-992X

Cand. Sci. (Med.), Associate Professor, Department of neurology neurosurgery and medical genetics department named after academician L.O. Badalian, Faculty of pediatrics

Russian Federation, Moscow

Maria А. Rukosueva

Immanuel Kant Baltic Federal University

Email: offelia78@mail.ru
ORCID iD: 0009-0003-5610-1839

clinical postgraduate student, Department of psychiatry and neurosciences

Russian Federation, Kaliningrad

References

  1. Robert C. A decade of immune-checkpoint inhibitors in cancer therapy. Nat. Commun. 2020;11(1):3801. doi: 10.1038/s41467-020-17670-y
  2. Twomey J.D., Zhang B. Cancer Immunotherapy update: FDA-approved checkpoint inhibitors and companion diagnostics. AAPS J. 2021;23(2):39. doi: 10.1208/s12248-021-00574-0
  3. Cuzzubbo S., Javeri F., Tissier M. et al. Neurological adverse events associated with immune checkpoint inhibitors: review of the literature. Eur. J. Cancer. 2017;73:1–8. doi: 10.1016/j.ejca.2016.12.001
  4. Sharma P., Allison J.P. Immune checkpoint targeting in cancer therapy: toward combination strategies with curative potential. Cell. 2015;161(2):205–214. doi: 10.1016/j.cell.2015.03.030
  5. Xu M., Nie Y., Yang Y. et al . Risk of neurological toxicities following the use of different immune checkpoint inhibitor regimens in solid tumors: a systematic review and meta-analysis. Neurologist. 2019;24(3):75–83. doi: 10.1097/NRL.0000000000000230
  6. Johnson D.B., Manouchehri A., Haugh A.M. et al. Neurologic toxicity associated with immune checkpoint inhibitors: a pharmacovigilance study. J. Immunother. Cancer. 2019;7(1):134. doi: 10.1186/s40425-019-0617-x
  7. Van den Bergh P.Y.K., van Doorn P.A., Hadden R.D.M. et al. European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: Report of a joint Task Force-Second revision. J. Peripher. Nerv. Syst. 2021;26(3):242–268. doi: 10.1111/jns.12455
  8. Супонева Н.А., Арестова А.С., Мельник Е.А. и др. Валидация шкалы суммарной оценки мышечной силы (MRC sum score) для использования у русскоязычных пациентов с хронической воспалительной демиелинизирующей полинейропатией. Нервно-мышечные болезни. 2023;13(1):68–74. Suponeva N.A., Arestova А.S., Melnik Е.А. et al. Validation of the Medical Research Council sum score (MRCss) for use in Russian-speaking patients with chronic inflammatory demyelinating polyneuropathy. Neuromuscular Diseases. 2023;13(1):68–74. doi: 10.17650/2222-8721-2023-13-1-68-74
  9. Khan E., Shrestha A.K., Elkhooly M. et al. CNS and PNS manifestation in immune checkpoint inhibitors: a systematic review. J. Neurol. Sci. 2022;432:120089. doi: 10.1016/j.jns.2021.120089
  10. Johansen A., Christensen S.J., Scheie D. et al.. Neuromuscular adverse events associated with anti-PD-1 monoclonal antibodies: systematic review. Neurology. 2019;92(14):663–674. doi: 10.1212/WNL.0000000000007235
  11. Puwanant A., Isfort M., Lacomis D. et al. Clinical spectrum of neuromuscular complications after immune checkpoint inhibition. Neuromuscul. Disord. 2019;29(2):127–133. doi: 10.1016/j.nmd.2018.11.012
  12. Ruggiero R., Balzano N., Di Napoli R. et al. Do peripheral neuropathies differ among immune checkpoint inhibitors? Reports from the European post-marketing surveillance database in the past 10 years. Front. Immunol. 2023;14:1134436. doi: 10.3389/fimmu.2023.1134436
  13. Van Raamsdonk C.D., Deo M. Links between Schwann cells and melanocytes in development and disease. Pigment Cell Melanoma Res. 2013;26(5):634–645. doi: 10.1111/pcmr.12134
  14. Okada K., Seki M., Yaguchi H. et al. Polyradiculoneuropathy induced by immune checkpoint inhibitors: a case series and review of the literature. J. Neurol. 2021;268(2):680–688. doi: 10.1007/s00415-020-10213-x
  15. Dubey D., David W.S., Amato A.A. et al. Varied phenotypes and management of immune checkpoint inhibitor-associated neuropathies. Neurology. 2019;93(11):e1093–e1103. doi: 10.1212/WNL.0000000000008091
  16. Kelly Wu W., Broman K.K., Brownie E.R., Kauffmann RM. Ipilimumab- induced Guillain–Barre syndrome presenting as dysautonomia: an unusual presentation of a rare complication of immunotherapy. J. Immunother.2017;40(5):196–199. doi: 10.1097/CJI.0000000000000167
  17. Тихонова О.А., Дружинин Д.С., Тынтерова А.М., Реверчук И.В. Современное представление о химиоиндуцированной полинейропатии (обзор литературы). Нервно-мышечные болезни. 2023;13(1):10–21. Tikhonova O.A., Druzhinin D.S., Tynterova A.M., Reverchuk I.V. Current understanding of chemotherapy-induced peripheral neuropathy. Neuromuscular Disease. 2023;13(1):10–21. doi: 10.17650/2222-8721-2023-13-1-10-21
  18. Patel A.S., Snook R.J., Sehdev A. Chronic inflammatory demyelinating polyradiculoneuropathy secondary to immune checkpoint inhibitors in me- lanoma patients. Discov. Med. 2019;28(152):107–111.
  19. Elkrief A., Derosa L., Zitvogel L. et al. The intimate relationship between gut microbiota and cancer immunotherapy. Gut Microbes. 2019;10(3):424–428. doi: 10.1080/19490976.2018.1527167
  20. Cappelli L.C., Gutierrez A.K., Bingham C.O. et al. Rheumatic and musculoskeletal immune-related adverse events due to immune checkpoint inhibitors: a systematic review of the literature. Arthritis Care Res. (Hoboken).2017;69(11):1751–1763. doi: 10.1002/acr.23177
  21. Brahmer J.R., Abu-Sbeih H., Ascierto P.A. et al. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immune checkpoint inhi- bitor-related adverse events. J. Immunother. Cancer. 2021;9(6). doi: 10.1136/jitc-2021-002435

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2. Fig. 1. Decreased conduction velocity in the median nerve in the forearm of patient F. to 27.1 m/s (normal range: > 49 m/s), prolonged distal latency to 9.1 ms (normal range: < 4.4 ms). Negative phase of proximal motor response lasted 18.7 ms. Dispersion of proximal motor response. Amplitude of distal motor response decreased to 1.1 mV (normal range: > 4 mV).

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3. Fig. 2. Conduction block of 52.9% (normal range: no block) in an atypical area of compression in the ulnar nerve. Amplitude of distal motor response decreased to 5.1 mV (normal range: > 6.0 mV). Distal latency was 3.19 ms (normal range: < 3.3 ms).

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Copyright (c) 2024 Tikhonova O.A., Druzhinin D.S., Druzhinina E.S., Rukosueva M.А.

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This work is licensed under a Creative Commons Attribution 4.0 International License.

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