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Mangioris G, Halfdanarson TR, Lennon VA, Chang BK, Dubey D, Dyck PJB, Flanagan EP, McKeon A, Mills JR, Pittock SJ, Zekeridou A. Neurological autoimmunity in patients with non-pulmonary neuroendocrine neoplasms: clinical manifestations and neural autoantibody profiles. Eur J Neurol 2024; 31:e16273. [PMID: 38466015 DOI: 10.1111/ene.16273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND AND PURPOSE Paraneoplastic neurological autoimmunity is well described with small-cell lung cancer, but information is limited for other neuroendocrine neoplasms (NENs). METHODS Adult patients with histopathologically confirmed non-pulmonary NENs, neurological autoimmunity within 5 years of NEN diagnosis, and neural antibody testing performed at the Mayo Clinic Neuroimmunology Laboratory (January 2008 to March 2023) were retrospectively identified. Control sera were available from patients with NENs without neurological autoimmunity (116). RESULTS Thirty-four patients were identified (median age 68 years, range 31-87). The most common primary tumor sites were pancreas (nine), skin (Merkel cell, eight), small bowel/duodenum (seven), and unknown (seven). Five patients received immune checkpoint inhibitor (ICI) therapy before symptom onset; symptoms preceded cancer diagnosis in 62.1% of non-ICI-treated patients. The most frequent neurological phenotypes (non-ICI-treated) were movement disorders (12; cerebellar ataxia in 10), dysautonomia (six), peripheral neuropathy (eight), encephalitis (four), and neuromuscular junction disorders (four). Neural antibodies were detected in 55.9% of patients studied (most common specificities: P/Q-type voltage-gated calcium channel [seven], muscle-type acetylcholine receptor [three], anti-neuronal nuclear antibody type 1 [three], and neuronal intermediate filaments [two]), but in only 6.9% of controls. Amongst patients receiving cancer or immunosuppressive therapy, 51.6% had partial or complete recovery. Outcomes were unfavorable in 48.3% (non-ICI-treated) and neural autoantibody positivity was associated with poor neurological outcome. DISCUSSION Neurological autoimmunity associated with non-pulmonary NENs is often multifocal and can be treatment responsive, underscoring the importance of rapid recognition and early treatment.
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Affiliation(s)
- Georgios Mangioris
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Vanda A Lennon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Immunology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bryce K Chang
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Divyanshu Dubey
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - P James B Dyck
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eoin P Flanagan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew McKeon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - John R Mills
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sean J Pittock
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Anastasia Zekeridou
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
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Zoccarato M, Grisold W. Paraneoplastic neurologic manifestations of neuroendocrine tumors. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:397-407. [PMID: 38494292 DOI: 10.1016/b978-0-12-823912-4.00023-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Neuroendocrine neoplasms (NENs) are a heterogeneous group of tumors arising from the transformation of neuroendocrine cells in several organs, most notably the gastro-entero-pancreatic system and respiratory tract. The classification was recently revised in the 5th Edition of the WHO Classification of Endocrine and Neuroendocrine Tumors. NENs can rarely spread to the central or peripheral nervous systems. Neurologic involvement is determined by the rare development of paraneoplastic syndromes, which are remote effects of cancer. Mechanisms depend on immunologic response to a tumor, leading to the immune attack on the nervous system or the production of biologically active ("functioning") substances, which can determine humoral (endocrine) effects with neurologic manifestations. Paraneoplastic neurologic syndromes (PNS) are immunologically mediated and frequently detected in small cell lung cancer but rarely seen in other forms of NEN. PNS and Merkel cell carcinoma is increasingly reported, especially with Lambert Eaton myasthenic syndrome. Endocrine manifestations are found in a wide spectrum of NENs. They can develop at any stage of the diseases and determine neurologic manifestations. Patient outcomes are influenced by tumor prognosis, neurologic complications, and the severity of endocrine effects.
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Affiliation(s)
- Marco Zoccarato
- Neurology Unit O.S.A., Azienda Ospedale-Università di Padova, Padova, Italy
| | - Wolfgang Grisold
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.
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Coskun O, Sahin H, Yalcin S, Sahin YC, Coskun U. Nivolumab-induced sensory ganglionopathy. J Oncol Pharm Pract 2023; 29:1510-1515. [PMID: 37254496 DOI: 10.1177/10781552231177712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Nivolumab is s a human monoclonal antibody. Due to its widespread use in many cancers, including Merkel cell carcinoma, adverse reactions associated with nivolumab, such as neuropathies, endocrinopathies, gastrointestinal problems, and skin toxicities have been increasing. Sensory ganlionopathy is rarely observed in these patients. CASE DESCRIPTION We present a 63-year-old male with a medical history of Merkel cell carcinoma that recurred two times in the inguinal region. After undergoing surgery with adjuvant radiotherapy, a second surgery was performed. The patient suffered from tingling in all four limbs plus difficulty in walking after initiation of the third dose of nivolumab. MANAGEMENT AND OUTCOME After 1 month of 1 mg/kg/day methylprednisolone treatment, he showed significant improvement. Subsequently, the systemic corticosteroid regimen was tapered to 5 mg every other day. The treatment resulted in significant improvement in all extremities. DISCUSSION Sensory ganlionopathy can be seen as a side effect of an immune checkpoint inhibitor, even though it is very extraordinary. This is the case in the literature to develop sensory ganlionopathy due to nivolumab. We believe that patients using nivolumab may develop sensory ganlionopathy and management should be taken on this point.
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Affiliation(s)
- Ozlem Coskun
- Department of Neurology, Kirikkale University School of Medicine, Kirikkale, Turkey
| | - Hasan Sahin
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Selim Yalcin
- Department of Neurology, Kirikkale University School of Medicine, Kirikkale, Turkey
| | - Yekta C Sahin
- Department of Nutrition and Dietetics, Ankara Medipol University School of Health Science, Ankara, Turkey
| | - Ugur Coskun
- Department of Neurology, Kirikkale University Faculty of Medicine, Kirikkale, Turkey
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Mercadé-Torras JM, Samaniego C, Sáez A, Yebenes M, Mazarico I. Paraneoplastic secretion of antidiuretic hormone in Merkel cell carcinoma: A case report. J Dermatol 2023; 50:e247-e248. [PMID: 36942530 DOI: 10.1111/1346-8138.16774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/07/2023] [Accepted: 02/23/2023] [Indexed: 03/23/2023]
Affiliation(s)
- Joan M Mercadé-Torras
- Acute Geriatric Unit, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Carla Samaniego
- Department of Primary Care, Parc Taulí Hospital Universitari, Sabadell, Spain
| | - Amparo Sáez
- Department of Pathology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Mireia Yebenes
- Department of Dermatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Isabel Mazarico
- Department of Endocrinology and Nutrition, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
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Ishay A, Touma E, Vornicova O, Dodiuk-Gad R, Goldman T, Bisharat N. Ectopic Cushing's syndrome in a patient with metastatic Merkel cell carcinoma: A case report. World J Clin Cases 2022; 10:7989-7993. [PMID: 36158508 PMCID: PMC9372868 DOI: 10.12998/wjcc.v10.i22.7989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/03/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ectopic Cushing syndrome (ECS) is a rare condition commonly associated with neuroendocrine tumors (NET), mainly bronchial carcinoids. The association of paraneoplastic syndrome with Merkle cell carcinoma (MCC) is limited to individual case reports.
CASE SUMMARY In this article we report an unusual and striking presentation of ECS in a patient with known metastatic MCC. An elderly patient presented with new onset severe hypertension, hyperglycemia and hypokalemia, muscle wasting, and peripheral edema. A diagnosis of adrenocorticotropic hormone dependent, non-pituitary, Cushing syndrome was established. Medical therapy inhibiting adrenal function was promptly started but unfortunately the patient survived only a few days after diagnosis.
CONCLUSION The occurrence of an aggressive form of ECS in patients with NET should be recognized as an ominous event. To our knowledge, the association of this complication in a patient with MCC had not been reported.
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Affiliation(s)
- Avraham Ishay
- Endocrine and Diabetes Unit, Emek Medical Center, Afula 18134, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Elia Touma
- Department of Internal Medicine D, Emek Medical Center, Afula 18134, Israel
| | - Olga Vornicova
- Department of Oncology, Emek Medical Center, Afula 18134, Israel
| | - Roni Dodiuk-Gad
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
- Department of Dermatology, Emek Medical Center, Afula 18134, Israel
| | - Tal Goldman
- Department of Pathology, Emek Medical Center, Afula 18134, Israel
| | - Naiel Bisharat
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
- Department of Medicine D, Emek Medical Center, Afula 18134, Israel
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6
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Subacute sensory neuronopathy associated with Merkel cell carcinoma with unknown primary: a case report with literature review. J Neurol 2022; 269:4080-4088. [DOI: 10.1007/s00415-022-11116-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 11/26/2022]
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7
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Paraneoplastic Syndromes in Patients with Keratinocyte Skin Cancer. Cancers (Basel) 2022; 14:cancers14010249. [PMID: 35008413 PMCID: PMC8750284 DOI: 10.3390/cancers14010249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/25/2021] [Accepted: 01/02/2022] [Indexed: 01/19/2023] Open
Abstract
Simple Summary The aim of the present review is to compile and evaluate the literature data on paraneoplastic syndromes (PNS) associated with keratinocyte skin cancer (KSC). Forty relevant entries were assembled, reporting a total of 41 PNS cases associated with a KSC (34 male). No review paper compiling this topic was found. Six distinct PNS entities were identified, and malignancy associated hypercalcemia (MAH; 78%), anemia (10%) and Bazex syndrome (5%) were the most frequently reported among them. 85% of the PNS were reported in association with SCC, 10% with BCC, and the rest with adnexal tumors. The median age of the patients at the time of PNS diagnosis was 58 years (range: five–83 years). KSC predisposing conditions, as scars (22%) or hidradenitis suppurativa (20%), were reported in >70% of the PNS cases. In conclusion, PNS are rarely reported in association with KSC, possibly reflecting a limited capacity of KSC to provoke overt PNS. Abstract A variety of well-characterized cutaneous paraneoplastic syndromes (PNS) are diagnosed during internal malignancies; however, the spectrum of keratinocyte skin neoplasms (KSC) related to PNS is still obscure. The aim of the present review is to compile and evaluate the literature data on PNS associated with a keratinocyte skin neoplasm (KSC). Employing Pubmed, MEDLINE was searched for KSC-associated PNS reports. Forty relevant entries were assembled, reporting a total of 41 PNS cases associated with a KSC (34 male). No review paper compiling this topic was found. Six distinct PNS entities were identified, and malignancy associated hypercalcemia (MAH; 78%), anemia (10%) and Bazex syndrome (5%) were the most frequently reported among them. 85% of the PNS were reported in association with SCC, 10% with BCC, and the rest with adnexal tumors. The median age of the patients at the time of PNS diagnosis was 58 years (range: five–83 years). In most cases the PNS was diagnosed either concurrently or after the KSC diagnosis. KSC predisposing conditions, as scars (22%) or hidradenitis suppurativa (20%), were reported in >70% of the PNS cases. Most PNS resolved after KSC treatment. In conclusion, PNS of a rather limited spectrum of entities are reported in association with KSC. They also seem to be rare, possibly reflecting a limited capacity of KSC to provoke overt PNS.
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Cells to Surgery Quiz: April 2021. J Invest Dermatol 2021. [PMID: 33752814 DOI: 10.1016/j.jid.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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9
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Benisty D, Kay S, Rund D, Katz BZ. Differential diagnosis of malignant mononuclear cells in the cerebrospinal fluid: Merkel carcinoma cells. Diagn Cytopathol 2020; 49:443-445. [PMID: 33264487 DOI: 10.1002/dc.24664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/08/2020] [Accepted: 11/03/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Dan Benisty
- Department of Hematology, Tel-Aviv University, Tel Aviv, Israel
| | - Sigi Kay
- Department of Hematology, Tel-Aviv University, Tel Aviv, Israel
| | - Deborah Rund
- Department of Hematology, Tel-Aviv University, Tel Aviv, Israel
| | - Ben-Zion Katz
- Department of Hematology, Tel-Aviv University, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Shalhout SZ, Emerick KS, Sadow PM, Linnoila JJ, Miller DM. Regionally Metastatic Merkel Cell Carcinoma Associated with Paraneoplastic Anti- N-methyl-D-aspartate Receptor Encephalitis. Case Rep Oncol Med 2020; 2020:1257587. [PMID: 33062358 PMCID: PMC7533778 DOI: 10.1155/2020/1257587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 11/23/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare and aggressive cutaneous neuroendocrine cancer with a high risk of recurrence and metastasis. MCC is generally associated with advanced age, fair skin, sun exposure, immunosuppression, and in the majority of cases, the Merkel cell polyomavirus. Neuroendocrine malignancies are associated with a variety of paraneoplastic neurological syndromes (PNS), characterized as autoimmune responses to malignancy-associated expression of neural antigens. Our literature review underscores previous case reports of MCC-associated PNS with voltage-gated calcium channel (VGCC) and anti-Hu (or ANNA-1) autoantibodies. We present the case of a 59-year-old male with regionally metastatic Merkel cell carcinoma complicated by the paraneoplastic manifestation of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. His primary lower neck subcutaneous MCC and metastasis were initially treated with surgery. Additional recurrent lymph node metastases were successfully treated with definitive intensity-modulated radiation therapy. His PNS improved with rituximab therapy. Although rare, this case highlights that in the setting of seizures and prominent psychiatric symptoms accompanying an MCC diagnosis, evaluation for autoimmune paraneoplastic encephalitis is warranted. Awareness and detection of preexisting PNS are crucial in the era of immune checkpoint inhibitors (ICI) for advanced MCC, where treatment with ICI has the potential to exacerbate preexisting autoimmune PNS and lead to worsened or even lethal neurologic immune-related adverse events (nirAEs).
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Affiliation(s)
- Sophia Z. Shalhout
- Division of Hematology/Oncology, Department of Medicine, and Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Kevin S. Emerick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
| | - Peter M. Sadow
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Jenny J. Linnoila
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - David M. Miller
- Division of Hematology/Oncology, Department of Medicine, and Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Sherry AD, Bezzerides M, Khattab MH, Luo G, Ancell KK, Kirschner AN. An autoimmune-based, paraneoplastic neurologic syndrome following checkpoint inhibition and concurrent radiotherapy for merkel cell carcinoma: case report. Strahlenther Onkol 2020; 196:664-670. [PMID: 32006066 DOI: 10.1007/s00066-020-01582-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 01/11/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Merkel cell carcinoma is highly sensitive to both radiation and immunotherapy. Moreover, concurrent radioimmunotherapy may capitalize on anti-tumor immune activity and improve Merkel cell treatment response, although an enhanced immune system may cross-react with native tissues and lead to significant sequelae. METHODS Here we present a case study of a patient with metastatic Merkel cell carcinoma treated with radiotherapy concurrent with pembrolizumab. RESULTS After radioimmunotherapy, the patient developed sensory neuropathy, visual hallucinations, and mixed motor neuron findings. Neurologic dysfunction progressed to profound gastrointestinal dysmotility necessitating parenteral nutrition and intubation with eventual expiration. CONCLUSION This case represents a unique autoimmune paraneoplastic neurologic syndrome, likely specific to neuroendocrine tumors and motivated by concurrent radioimmunotherapy. Recognition of the potential role of radioimmunotherapy may provide an advantage in anticipating these severe sequelae.
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MESH Headings
- Aged
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Agents, Immunological/adverse effects
- Antineoplastic Agents, Immunological/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Autoimmune Diseases of the Nervous System/etiology
- Autoimmune Diseases of the Nervous System/immunology
- Axilla
- Carboplatin/administration & dosage
- Carcinoma, Merkel Cell/drug therapy
- Carcinoma, Merkel Cell/radiotherapy
- Carcinoma, Merkel Cell/secondary
- Combined Modality Therapy
- Deglutition Disorders/etiology
- Etoposide/administration & dosage
- Fatal Outcome
- Fingers
- Hallucinations/etiology
- Humans
- Lymphatic Metastasis/diagnostic imaging
- Lymphatic Metastasis/radiotherapy
- Male
- Neuralgia/drug therapy
- Neuralgia/etiology
- Palliative Care
- Paraneoplastic Syndromes, Nervous System/etiology
- Paraneoplastic Syndromes, Nervous System/immunology
- Parenteral Nutrition, Total
- Pneumonia, Aspiration/etiology
- Positron Emission Tomography Computed Tomography
- Radioimmunotherapy/adverse effects
- Radiotherapy, High-Energy
- Radiotherapy, Intensity-Modulated/adverse effects
- Skin Neoplasms/drug therapy
- Skin Neoplasms/radiotherapy
- Skin Neoplasms/secondary
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Affiliation(s)
| | | | - Mohamed H Khattab
- Department of Radiation Oncology, Vanderbilt University Medical Center, 2220 Pierce Avenue, PRB-B1003, Nashville, TN, USA
| | - Guozhen Luo
- Department of Radiation Oncology, Vanderbilt University Medical Center, 2220 Pierce Avenue, PRB-B1003, Nashville, TN, USA
| | - Kristin K Ancell
- Department of Medicine, Division of Hematology Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Austin N Kirschner
- Department of Radiation Oncology, Vanderbilt University Medical Center, 2220 Pierce Avenue, PRB-B1003, Nashville, TN, USA.
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Hooiveld-Noeken J, Fehrmann R, de Vries E, Jalving M. Driving innovation for rare skin cancers: utilizing common tumours and machine learning to predict immune checkpoint inhibitor response. IMMUNO-ONCOLOGY TECHNOLOGY 2019; 4:1-7. [PMID: 35755000 PMCID: PMC9216707 DOI: 10.1016/j.iotech.2019.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/15/2019] [Accepted: 11/19/2019] [Indexed: 12/30/2022]
Abstract
Metastatic Merkel cell carcinoma (MCC) and cutaneous squamous cell carcinoma (cSCC) are rare and both show impressive responses to immune checkpoint inhibitor treatment. However, at least 40% of patients do not respond to these expensive and potentially toxic drugs. Development of predictive biomarkers of response and rational, effective combination treatment strategies in these rare, often frail patient populations is challenging. This review discusses the pathophysiology and treatment of MCC and cSCC, with a particular focus on potential biomarkers of response to immunotherapy, and discusses how transfer learning using big data collected from patients with common tumours can be used in combination with deep phenotyping of rare tumours to develop predictive biomarkers and elucidate novel treatment targets. Metastatic Merkel cell carcinoma and cutaneous squamous cell carcinoma are rare tumours. Immunotherapy gives impressive responses but most patients do not survive long term. Small patient numbers prevent extensive biomarker research in clinical trials. Pooled data from common and rare tumours can be used to train neural networks. In rare cancers, neural networks can help identify biomarkers and novel treatment targets.
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Queen D, Gu Y, Lopez A, Chen D, Geskin LJ. Paraneoplastic cerebellar ataxia in Merkel cell carcinoma of unknown primary. JAAD Case Rep 2019; 5:398-400. [PMID: 31049380 PMCID: PMC6479110 DOI: 10.1016/j.jdcr.2019.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Dawn Queen
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Yuhan Gu
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Adriana Lopez
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Diane Chen
- Department of Pathology, Columbia University Irving Medical Center, New York, New York
| | - Larisa J. Geskin
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
- Correspondence to: Larisa J. Geskin, MD, 161 Fort Washington Ave, 12th Floor, New York, NY 10032.
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Basal E, Zalewski N, Kryzer TJ, Hinson SR, Guo Y, Dubey D, Benarroch EE, Lucchinetti CF, Pittock SJ, Lennon VA, McKeon A. Paraneoplastic neuronal intermediate filament autoimmunity. Neurology 2018; 91:e1677-e1689. [PMID: 30282771 PMCID: PMC6207411 DOI: 10.1212/wnl.0000000000006435] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 07/23/2018] [Indexed: 12/13/2022] Open
Abstract
Objective To describe paraneoplastic neuronal intermediate filament (NIF) autoimmunity. Methods Archived patient and control serum and CSF specimens were evaluated by tissue-based indirect immunofluorescence assay (IFA). Autoantigens were identified by Western blot and mass spectrometry. NIF specificity was confirmed by dual tissue section staining and 5 recombinant NIF-specific HEK293 cell-based assays (CBAs, for α-internexin, neurofilament light [NfL], neurofilament medium, or neurofilament heavy chain, and peripherin). NIF–immunoglobulin Gs (IgGs) were correlated with neurologic syndromes and cancers. Results Among 65 patients, NIF-IgG-positive by IFA and CBAs, 33 were female (51%). Median symptom onset age was 62 years (range 18–88). Patients fell into 2 groups, defined by the presence of NfL-IgG (21 patients, who mostly had ≥4 NIF-IgGs detected) or its absence (44 patients, who mostly had ≤2 NIF-IgGs detected). Among NfL-IgG-positive patients, 19/21 had ≥1 subacute onset CNS disorders: cerebellar ataxia (11), encephalopathy (11), or myelopathy (2). Cancers were detected in 16 of 21 patients (77%): carcinomas of neuroendocrine lineage (10) being most common (small cell [5], Merkel cell [3], other neuroendocrine [2]). Two of 257 controls (0.8%, both with small cell carcinoma) were positive by both IFA and CBA. Five of 7 patients with immunotherapy data improved. By comparison, the 44 NfL-IgG-negative patients had findings of unclear significance: diverse nervous system disorders (p = 0.006), as well as limited (p = 0.003) and more diverse (p < 0.0001) cancer accompaniments. Conclusions NIF-IgG detection by IFA, with confirmatory CBA testing that yields a profile including NfL-IgG, defines a paraneoplastic CNS disorder (usually ataxia or encephalopathy) accompanying neuroendocrine lineage neoplasia.
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Affiliation(s)
- Eati Basal
- From the Departments of Laboratory Medicine and Pathology (E.B., T.J.K., S.R.H., S.J.P., V.A.L., A.M.), Neurology (N.Z., Y.G., D.D., E.E.B., C.F.L., S.J.P., V.A.L., A.M.), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Nicholas Zalewski
- From the Departments of Laboratory Medicine and Pathology (E.B., T.J.K., S.R.H., S.J.P., V.A.L., A.M.), Neurology (N.Z., Y.G., D.D., E.E.B., C.F.L., S.J.P., V.A.L., A.M.), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Thomas J Kryzer
- From the Departments of Laboratory Medicine and Pathology (E.B., T.J.K., S.R.H., S.J.P., V.A.L., A.M.), Neurology (N.Z., Y.G., D.D., E.E.B., C.F.L., S.J.P., V.A.L., A.M.), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Shannon R Hinson
- From the Departments of Laboratory Medicine and Pathology (E.B., T.J.K., S.R.H., S.J.P., V.A.L., A.M.), Neurology (N.Z., Y.G., D.D., E.E.B., C.F.L., S.J.P., V.A.L., A.M.), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Yong Guo
- From the Departments of Laboratory Medicine and Pathology (E.B., T.J.K., S.R.H., S.J.P., V.A.L., A.M.), Neurology (N.Z., Y.G., D.D., E.E.B., C.F.L., S.J.P., V.A.L., A.M.), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Divyanshu Dubey
- From the Departments of Laboratory Medicine and Pathology (E.B., T.J.K., S.R.H., S.J.P., V.A.L., A.M.), Neurology (N.Z., Y.G., D.D., E.E.B., C.F.L., S.J.P., V.A.L., A.M.), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Eduardo E Benarroch
- From the Departments of Laboratory Medicine and Pathology (E.B., T.J.K., S.R.H., S.J.P., V.A.L., A.M.), Neurology (N.Z., Y.G., D.D., E.E.B., C.F.L., S.J.P., V.A.L., A.M.), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Claudia F Lucchinetti
- From the Departments of Laboratory Medicine and Pathology (E.B., T.J.K., S.R.H., S.J.P., V.A.L., A.M.), Neurology (N.Z., Y.G., D.D., E.E.B., C.F.L., S.J.P., V.A.L., A.M.), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Sean J Pittock
- From the Departments of Laboratory Medicine and Pathology (E.B., T.J.K., S.R.H., S.J.P., V.A.L., A.M.), Neurology (N.Z., Y.G., D.D., E.E.B., C.F.L., S.J.P., V.A.L., A.M.), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Vanda A Lennon
- From the Departments of Laboratory Medicine and Pathology (E.B., T.J.K., S.R.H., S.J.P., V.A.L., A.M.), Neurology (N.Z., Y.G., D.D., E.E.B., C.F.L., S.J.P., V.A.L., A.M.), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Andrew McKeon
- From the Departments of Laboratory Medicine and Pathology (E.B., T.J.K., S.R.H., S.J.P., V.A.L., A.M.), Neurology (N.Z., Y.G., D.D., E.E.B., C.F.L., S.J.P., V.A.L., A.M.), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN.
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Radiation Therapy in Merkel Cell Carcinoma. Radiat Oncol 2018. [DOI: 10.1007/978-3-319-52619-5_16-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Sharobeam A, Ray J, Dong J, Chong V. Subacute Cerebellar Degeneration due to a Paraneoplastic Phenomenon Associated with Metastatic Merkel Cell Carcinoma: A Case Report. Case Rep Oncol 2017; 10:764-768. [PMID: 28878663 PMCID: PMC5582522 DOI: 10.1159/000479731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 07/25/2017] [Indexed: 01/30/2023] Open
Abstract
Purpose The aim of this article is to illustrate the diagnostic challenges and management of paraneoplastic neurological syndromes in Merkel cell carcinoma. Materials and Methods We describe a previously functionally independent 85-year-old woman who presented with subacute onset of dizziness and gait ataxia in the setting of metastatic Merkel cell carcinoma. Results Diagnosis was made on biopsy after positron emission tomography imaging revealed increased metabolic activity in 2 left inguinofemoral lymph nodes. Cerebrospinal fluid analysis was positive for anti-Hu on subsequent admission. Her functional status improved with methylprednisolone treatment and radiotherapy. Conclusion The case highlights the challenge of the evaluation of patients who present with progressive cerebellar signs and the need to consider a paraneoplastic syndrome, especially in the setting of previous malignancy.
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Affiliation(s)
| | - Jason Ray
- Melbourne Health, Parkville, Victoria, Australia
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