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Urai S, Tomofuji S, Bando H, Kanzawa M, Yamamoto M, Fukuoka H, Tsuda M, Iguchi G, Ogawa W. The early-stage clinical course of anti-pituitary-specific transcription factor-1 hypophysitis diagnosed post-immune checkpoint inhibitor treatment: A case with review of literature. J Neuroendocrinol 2024; 36:e13395. [PMID: 38631695 DOI: 10.1111/jne.13395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/02/2024] [Accepted: 04/06/2024] [Indexed: 04/19/2024]
Abstract
Anti-pituitary-specific transcription factor-1 (PIT-1) hypophysitis, a paraneoplastic syndrome resulting from an autoimmune response against PIT-1, typically manifests with undetectable levels of growth hormone (GH) and prolactin (PRL), and significantly low levels of serum thyroid-stimulating hormone (TSH) at diagnosis. These hormonal levels are highly specific to this disease and serve as key diagnostic indicators. Herein, we present a detailed clinical course of a 69-year-old male with a history of gastric cancer and lymph node metastases who developed anti-PIT-1 hypophysitis after the initiation of immune checkpoint inhibitor (ICI) therapy, specifically nivolumab, oxaliplatin, and capecitabine. The patient was referred to our department owing to decreased TSH, free triiodothyronine (T3), and free thyroxine (T4) levels after two doses of nivolumab. Initially suspected as central hypothyroidism due to ICI-related hypophysitis, further assessment confirmed the diagnosis of anti-PIT-1 hypophysitis. Notably, GH, PRL, and TSH levels markedly declined, leading to complete deficiencies 2 months after the first nivolumab dose-a pattern consistent with that of previous cases of anti-PIT-1 hypophysitis. Therefore, this report not only presents an atypical subset of ICI-related hypophysitis but also delineates the process of hormone impairment leading to complete deficiencies in anti-PIT-1 hypophysitis. This case highlights the importance of vigilant monitoring for endocrine issues in patients undergoing ICI therapy, given the escalating incidence of immune-related adverse events associated with the extensive use of ICI therapy for various cancers.
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Affiliation(s)
- Shin Urai
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Diabetes and Endocrinology, Hyogo Cancer Center, Akashi, Japan
| | - Seiji Tomofuji
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Hospital, Kobe, Japan
| | - Hironori Bando
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Hospital, Kobe, Japan
| | - Maki Kanzawa
- Division of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaaki Yamamoto
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidenori Fukuoka
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Hospital, Kobe, Japan
| | - Masahiro Tsuda
- Department of Gastroenterological Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Genzo Iguchi
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
- Medical Center for Student Health, Kobe University, Kobe, Japan
- Division of Biosignal Pathophysiology, Kobe University, Kobe, Japan
| | - Wataru Ogawa
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Vaghi G, Vegezzi E, Bini P, Gastaldi M, Diamanti L, Marchioni E, Colnaghi S. A Case of Anti-Ma2 Encephalitis Presenting with Pendular Torsional Nystagmus. CEREBELLUM (LONDON, ENGLAND) 2024; 23:1249-1253. [PMID: 37848701 PMCID: PMC11102397 DOI: 10.1007/s12311-023-01601-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 10/19/2023]
Abstract
Antibodies against the neuronal protein Ma2 have been reported in a peculiar form of paraneoplastic encephalitis with prominent involvement of the limbic, brainstem, and diencephalic structures and usually associated with germ cell testicular, lung, or breast cancer. The diagnosis is frequently challenged by atypical clinical manifestations including parkinsonism, sleep disturbances, hypothalamic-pituitary dysfunctions, and motor neuron-like syndrome. In recent years, the advent of monoclonal antibodies targeting immune checkpoints has deeply changed the treatment of different tumors, especially melanoma and lung cancer. However, given their nature, an increasing number of neurological immune-related adverse events, including ocular motor abnormalities, have been described. Here, we report a woman with advanced non-small cell lung cancer treated with anti-PD-L1 durvalumab, presenting with an isolated pendular torsional nystagmus, in association with anti-Ma2 antibodies. This peculiar case widens our knowledge on the clinical presentation of anti-Ma2 encephalitis associated with checkpoint inhibitors.
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Affiliation(s)
- Gloria Vaghi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy.
| | - Elisa Vegezzi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Neuroncology and Neuroinflammation Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Paola Bini
- Neuroncology and Neuroinflammation Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Matteo Gastaldi
- Neuroncology and Neuroinflammation Unit, IRCCS Mondino Foundation, Pavia, Italy
- Neuroimmunology Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Luca Diamanti
- Neuroncology and Neuroinflammation Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Enrico Marchioni
- Neuroncology and Neuroinflammation Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Silvia Colnaghi
- Neurology Unit, Dipartimento Funzionale Sperimentale Interaziendale di Neuroscienze, ASST, Pavia, Italy
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Ross LA, Lee J, Carlson AK, Conway DS, Cohen JA, Graves J, Zamvil SS, Newsome SD, Kunchok A. Progressive Encephalomyelopathy in an Older Man: A Case Report From the National Multiple Sclerosis Society Case Conference Proceedings. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200210. [PMID: 38386951 PMCID: PMC10900913 DOI: 10.1212/nxi.0000000000200210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/12/2024] [Indexed: 02/24/2024]
Abstract
We present a case of subacute onset progressive encephalomyelopathy in a 77-year-old man with symmetric lateral column signal abnormalities on spinal MRI. We discuss the differential and presumptive final diagnosis along with a review of the postulated disease immunopathogenesis.
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Affiliation(s)
- Lindsay A Ross
- From the Mellen Center for Multiple Sclerosis Treatment and Research (L.A.R., A.K.C., D.S.C., J.A.C., A.K.) and Diagnostic Radiology (J.L.), Cleveland Clinic, OH; Department of Neurosciences (J.G.), University of California San Diego, La Jolla, CA; UCSF Weill Institute of Neurosciences (S.S.Z.), University of California at San Francisco; and Department of Neurology (S.D.N.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Jonathan Lee
- From the Mellen Center for Multiple Sclerosis Treatment and Research (L.A.R., A.K.C., D.S.C., J.A.C., A.K.) and Diagnostic Radiology (J.L.), Cleveland Clinic, OH; Department of Neurosciences (J.G.), University of California San Diego, La Jolla, CA; UCSF Weill Institute of Neurosciences (S.S.Z.), University of California at San Francisco; and Department of Neurology (S.D.N.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Alise K Carlson
- From the Mellen Center for Multiple Sclerosis Treatment and Research (L.A.R., A.K.C., D.S.C., J.A.C., A.K.) and Diagnostic Radiology (J.L.), Cleveland Clinic, OH; Department of Neurosciences (J.G.), University of California San Diego, La Jolla, CA; UCSF Weill Institute of Neurosciences (S.S.Z.), University of California at San Francisco; and Department of Neurology (S.D.N.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Devon S Conway
- From the Mellen Center for Multiple Sclerosis Treatment and Research (L.A.R., A.K.C., D.S.C., J.A.C., A.K.) and Diagnostic Radiology (J.L.), Cleveland Clinic, OH; Department of Neurosciences (J.G.), University of California San Diego, La Jolla, CA; UCSF Weill Institute of Neurosciences (S.S.Z.), University of California at San Francisco; and Department of Neurology (S.D.N.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Jeffrey A Cohen
- From the Mellen Center for Multiple Sclerosis Treatment and Research (L.A.R., A.K.C., D.S.C., J.A.C., A.K.) and Diagnostic Radiology (J.L.), Cleveland Clinic, OH; Department of Neurosciences (J.G.), University of California San Diego, La Jolla, CA; UCSF Weill Institute of Neurosciences (S.S.Z.), University of California at San Francisco; and Department of Neurology (S.D.N.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Jennifer Graves
- From the Mellen Center for Multiple Sclerosis Treatment and Research (L.A.R., A.K.C., D.S.C., J.A.C., A.K.) and Diagnostic Radiology (J.L.), Cleveland Clinic, OH; Department of Neurosciences (J.G.), University of California San Diego, La Jolla, CA; UCSF Weill Institute of Neurosciences (S.S.Z.), University of California at San Francisco; and Department of Neurology (S.D.N.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Scott S Zamvil
- From the Mellen Center for Multiple Sclerosis Treatment and Research (L.A.R., A.K.C., D.S.C., J.A.C., A.K.) and Diagnostic Radiology (J.L.), Cleveland Clinic, OH; Department of Neurosciences (J.G.), University of California San Diego, La Jolla, CA; UCSF Weill Institute of Neurosciences (S.S.Z.), University of California at San Francisco; and Department of Neurology (S.D.N.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Scott D Newsome
- From the Mellen Center for Multiple Sclerosis Treatment and Research (L.A.R., A.K.C., D.S.C., J.A.C., A.K.) and Diagnostic Radiology (J.L.), Cleveland Clinic, OH; Department of Neurosciences (J.G.), University of California San Diego, La Jolla, CA; UCSF Weill Institute of Neurosciences (S.S.Z.), University of California at San Francisco; and Department of Neurology (S.D.N.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Amy Kunchok
- From the Mellen Center for Multiple Sclerosis Treatment and Research (L.A.R., A.K.C., D.S.C., J.A.C., A.K.) and Diagnostic Radiology (J.L.), Cleveland Clinic, OH; Department of Neurosciences (J.G.), University of California San Diego, La Jolla, CA; UCSF Weill Institute of Neurosciences (S.S.Z.), University of California at San Francisco; and Department of Neurology (S.D.N.), Johns Hopkins School of Medicine, Baltimore, MD
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Aboseif A, Vorasoot N, Pinto MV, Guo Y, Hasan S, Zekeridou A, Chen JJ, Dubey D. Immune Checkpoint Inhibitor-Associated Kelch-Like Protein-11 IgG Brainstem Encephalitis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200218. [PMID: 38484218 DOI: 10.1212/nxi.0000000000200218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/19/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVES Kelch-like protein-11 (KLHL11)-IgG is associated with rhombencephalitis and seminoma. It has not previously been described as a neurologic immune checkpoint inhibitor (ICI)-related adverse event (nirAE) or in association with esophageal adenocarcinoma. METHODS We describe a 61-year-old man with metastatic esophageal adenocarcinoma treated with folinic acid, fluorouracil, oxaliplatin (FOLFOX), and nivolumab, who subsequently developed diplopia, vertigo, and progressive gait ataxia after 8 weeks of treatment. RESULTS Owing to a concern for ICI-associated myasthenia gravis, nivolumab was held and he was treated with prednisone and pyridostigmine. EMG showed no neuromuscular junction dysfunction, and acetylcholine-receptor antibodies were negative. Brain MRI was unrevealing. Murine brain tissue immunofluorescence assay revealed KLHL11-IgG in both serum and CSF, confirmed by cell-based assay. Tumor histopathology demonstrated poorly differentiated, highly proliferative adenocarcinoma with increased mitotic figures and cytoplasmic KLHL11 immunoreactivity. He was initiated on 6 months of cyclophosphamide in addition to FOLFOX for post-ICI-associated KLHL11-IgG rhombencephalitis. DISCUSSION We report KLHL11-IgG rhombencephalitis associated with poorly differentiated esophageal cancer as a novel nirAE. Tumor staining revealed KLHL11 immunoreactivity, supporting a cancer-antigen-driven ICI-associated paraneoplastic syndrome. Recognition of novel nirAEs can expedite treatment and potentially prevent progressive neurologic disability.
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Affiliation(s)
- Albert Aboseif
- From the Center for Multiple Sclerosis and Autoimmune Neurology (A.A., N.V., Y.G., S.H., A.Z., J.J.C., D.D.), Department of Neurology; Department of Laboratory Medicine and Pathology (N.V., Y.G., A.Z., D.D.); Department of Neurology (N.V.), Mayo Clinic College of Medicine, Rochester, MN; Division of Neurology (M.V.P.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; and Department of Ophthalmology (J.J.C.), Mayo Clinic College of Medicine, Rochester, MN
| | - Nisa Vorasoot
- From the Center for Multiple Sclerosis and Autoimmune Neurology (A.A., N.V., Y.G., S.H., A.Z., J.J.C., D.D.), Department of Neurology; Department of Laboratory Medicine and Pathology (N.V., Y.G., A.Z., D.D.); Department of Neurology (N.V.), Mayo Clinic College of Medicine, Rochester, MN; Division of Neurology (M.V.P.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; and Department of Ophthalmology (J.J.C.), Mayo Clinic College of Medicine, Rochester, MN
| | - Marcus V Pinto
- From the Center for Multiple Sclerosis and Autoimmune Neurology (A.A., N.V., Y.G., S.H., A.Z., J.J.C., D.D.), Department of Neurology; Department of Laboratory Medicine and Pathology (N.V., Y.G., A.Z., D.D.); Department of Neurology (N.V.), Mayo Clinic College of Medicine, Rochester, MN; Division of Neurology (M.V.P.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; and Department of Ophthalmology (J.J.C.), Mayo Clinic College of Medicine, Rochester, MN
| | - Yong Guo
- From the Center for Multiple Sclerosis and Autoimmune Neurology (A.A., N.V., Y.G., S.H., A.Z., J.J.C., D.D.), Department of Neurology; Department of Laboratory Medicine and Pathology (N.V., Y.G., A.Z., D.D.); Department of Neurology (N.V.), Mayo Clinic College of Medicine, Rochester, MN; Division of Neurology (M.V.P.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; and Department of Ophthalmology (J.J.C.), Mayo Clinic College of Medicine, Rochester, MN
| | - Shemonti Hasan
- From the Center for Multiple Sclerosis and Autoimmune Neurology (A.A., N.V., Y.G., S.H., A.Z., J.J.C., D.D.), Department of Neurology; Department of Laboratory Medicine and Pathology (N.V., Y.G., A.Z., D.D.); Department of Neurology (N.V.), Mayo Clinic College of Medicine, Rochester, MN; Division of Neurology (M.V.P.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; and Department of Ophthalmology (J.J.C.), Mayo Clinic College of Medicine, Rochester, MN
| | - Anastasia Zekeridou
- From the Center for Multiple Sclerosis and Autoimmune Neurology (A.A., N.V., Y.G., S.H., A.Z., J.J.C., D.D.), Department of Neurology; Department of Laboratory Medicine and Pathology (N.V., Y.G., A.Z., D.D.); Department of Neurology (N.V.), Mayo Clinic College of Medicine, Rochester, MN; Division of Neurology (M.V.P.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; and Department of Ophthalmology (J.J.C.), Mayo Clinic College of Medicine, Rochester, MN
| | - John J Chen
- From the Center for Multiple Sclerosis and Autoimmune Neurology (A.A., N.V., Y.G., S.H., A.Z., J.J.C., D.D.), Department of Neurology; Department of Laboratory Medicine and Pathology (N.V., Y.G., A.Z., D.D.); Department of Neurology (N.V.), Mayo Clinic College of Medicine, Rochester, MN; Division of Neurology (M.V.P.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; and Department of Ophthalmology (J.J.C.), Mayo Clinic College of Medicine, Rochester, MN
| | - Divyanshu Dubey
- From the Center for Multiple Sclerosis and Autoimmune Neurology (A.A., N.V., Y.G., S.H., A.Z., J.J.C., D.D.), Department of Neurology; Department of Laboratory Medicine and Pathology (N.V., Y.G., A.Z., D.D.); Department of Neurology (N.V.), Mayo Clinic College of Medicine, Rochester, MN; Division of Neurology (M.V.P.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; and Department of Ophthalmology (J.J.C.), Mayo Clinic College of Medicine, Rochester, MN
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Cincotta MC, Walker RH. Recent advances in non-Huntington's disease choreas. Parkinsonism Relat Disord 2024; 122:106045. [PMID: 38378310 DOI: 10.1016/j.parkreldis.2024.106045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/10/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Chorea is primarily due to an imbalance of basal ganglia output pathways, often due to dysfunction or degeneration of the caudate nucleus and putamen, and can be due to many causes. METHODS We reviewed the recent literature to identify newly-recognized causes of chorea, including auto-immune, metabolic, and genetic. We also focused upon developments in mechanisms relating to underlying pathophysiology of certain genetic choreas and advances in therapeutics. RESULTS Novel autoantibodies continue to be identified as causes of chorea. Both COVID-19 infection and vaccination are reported to result rarely in chorea, although in some cases causality is not clearly established. Advances in genetic testing continue to find more causes of chorea, and to expand the phenotype of known genetic disorders. Deep brain stimulation can be successful in certain circumstances. CONCLUSION Our understanding of mechanisms underlying this movement disorder continues to advance, however much remains to be elucidated.
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Affiliation(s)
- Molly C Cincotta
- Department of Neurology, Temple University, Philadelphia, PA, USA
| | - Ruth H Walker
- Department of Neurology, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Neurology, Mount Sinai School of Medicine, New York City, NY, USA.
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Zammit F, Seront E. Neurological Adverse Events Related to Immune Checkpoint Inhibitors: A Practical Review. Pharmaceuticals (Basel) 2024; 17:501. [PMID: 38675461 PMCID: PMC11053462 DOI: 10.3390/ph17040501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
The increasing use of immune checkpoint inhibitors (ICI) in cancer therapy has brought attention to their associated neurotoxicities, termed neurological immune-related adverse events (n-irAEs). Despite their relatively rare incidence, n-irAEs pose a significant risk, potentially leading to severe, long-lasting disabilities or even fatal outcomes. This narrative review aims to provide a comprehensive overview of n-irAEs, focusing on their recognition and management. The review addresses a spectrum of n-irAEs, encompassing myositis, myasthenia gravis, various neuropathies, and central nervous system complications, such as encephalitis, meningitis, and demyelinating diseases. The key features of n-irAEs are emphasized in this review, including their early onset after initiation of ICIs, potential association with non-neurological irAEs and/or concurrent oncological response, the significance of ruling out other etiologies, and the expected improvement upon discontinuation of ICIs and/or immunosuppression. Furthermore, this review delves into considerations for ICI re-challenge and the intricate nature of n-irAEs within the context of pre-existing autoimmune and paraneoplastic syndromes. It underscores the importance of a multidisciplinary approach to diagnosis and treatment, highlighting the pivotal role of severity grading in guiding treatment decisions.
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Affiliation(s)
| | - Emmanuel Seront
- Institut Roi Albert II, Department of Medical Oncology, Cliniques Universitaires Saint Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium;
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Casagrande S, Sopetto GB, Bertalot G, Bortolotti R, Racanelli V, Caffo O, Giometto B, Berti A, Veccia A. Immune-Related Adverse Events Due to Cancer Immunotherapy: Immune Mechanisms and Clinical Manifestations. Cancers (Basel) 2024; 16:1440. [PMID: 38611115 PMCID: PMC11011060 DOI: 10.3390/cancers16071440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
The landscape of cancer treatment has undergone a significant transformation with the introduction of Immune Checkpoint Inhibitors (ICIs). Patients undergoing these treatments often report prolonged clinical and radiological responses, albeit with a potential risk of developing immune-related adverse events (irAEs). Here, we reviewed and discussed the mechanisms of action of ICIs and their pivotal role in regulating the immune system to enhance the anti-tumor immune response. We scrutinized the intricate pathogenic mechanisms responsible for irAEs, arising from the evasion of self-tolerance checkpoints due to drug-induced immune modulation. We also summarized the main clinical manifestations due to irAEs categorized by organ types, detailing their incidence and associated risk factors. The occurrence of irAEs is more frequent when ICIs are combined; with neurological, cardiovascular, hematological, and rheumatic irAEs more commonly linked to PD1/PD-L1 inhibitors and cutaneous and gastrointestinal irAEs more prevalent with CTLA4 inhibitors. Due to the often-nonspecific signs and symptoms, the diagnosis of irAEs (especially for those rare ones) can be challenging. The differential with primary autoimmune disorders becomes sometimes intricate, given the clinical and pathophysiological similarities. In conclusion, considering the escalating use of ICIs, this area of research necessitates additional clinical studies and practical insights, especially the development of biomarkers for predicting immune toxicities. In addition, there is a need for heightened education for both clinicians and patients to enhance understanding and awareness.
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Affiliation(s)
- Silvia Casagrande
- Unit of Neurology, Rovereto Hospital, Azienda Provinciale per i Servizi Sanitari-APSS, 38122 Trento, Italy; (S.C.); (B.G.)
| | - Giulia Boscato Sopetto
- Department of Cellular, Computational and Integrative Biology (CIBIO), University of Trento, 38122 Trento, Italy; (G.B.S.); (G.B.); (V.R.)
| | - Giovanni Bertalot
- Department of Cellular, Computational and Integrative Biology (CIBIO), University of Trento, 38122 Trento, Italy; (G.B.S.); (G.B.); (V.R.)
- Center for Medical Sciences (CISMed), University of Trento, 38122 Trento, Italy
- Multizonal Unit of Pathology, APSS, 38122 Trento, Italy
| | - Roberto Bortolotti
- Unit of Rheumatology, Santa Chiara Regional Hospital, APSS, 38122 Trento, Italy;
| | - Vito Racanelli
- Department of Cellular, Computational and Integrative Biology (CIBIO), University of Trento, 38122 Trento, Italy; (G.B.S.); (G.B.); (V.R.)
- Center for Medical Sciences (CISMed), University of Trento, 38122 Trento, Italy
- Unit of Internal Medicine, Santa Chiara Regional Hospital, APSS, 38122 Trento, Italy
| | - Orazio Caffo
- Unit of Oncology, Santa Chiara Regional Hospital, APSS, 38122 Trento, Italy; (O.C.); (A.V.)
| | - Bruno Giometto
- Unit of Neurology, Rovereto Hospital, Azienda Provinciale per i Servizi Sanitari-APSS, 38122 Trento, Italy; (S.C.); (B.G.)
- Center for Medical Sciences (CISMed), University of Trento, 38122 Trento, Italy
- Department of Psychology and Cognitive Sciences (DIPSCO), University of Trento, 38122 Trento, Italy
| | - Alvise Berti
- Department of Cellular, Computational and Integrative Biology (CIBIO), University of Trento, 38122 Trento, Italy; (G.B.S.); (G.B.); (V.R.)
- Center for Medical Sciences (CISMed), University of Trento, 38122 Trento, Italy
- Unit of Rheumatology, Santa Chiara Regional Hospital, APSS, 38122 Trento, Italy;
| | - Antonello Veccia
- Unit of Oncology, Santa Chiara Regional Hospital, APSS, 38122 Trento, Italy; (O.C.); (A.V.)
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8
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Seki T, Baba K, Hayashi T, Furuta R, Hirosawa H, Mitsui T, Maesaka H, Takasawa S, Miwa T, Tanaka K, Nakatsuji Y. Lung Cancer Wherein Durvalumab Induced Both Anti-CRMP-5 Antibody-related Paraneoplastic Neurological Syndromes and Neurological Adverse Events. Intern Med 2024; 63:1009-1014. [PMID: 37612090 PMCID: PMC11045384 DOI: 10.2169/internalmedicine.1771-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/17/2023] [Indexed: 08/25/2023] Open
Abstract
A 68-year-old man with small-cell lung cancer developed anti-collapsin response-mediator protein (CRMP)-5 antibody-related paraneoplastic neurological syndrome (PNS) presenting with ataxia and chorea during treatment with durvalumab. As a result of steroid therapy, anti-CRMP-5 antibodies became negative, hyperintense lesions on brain magnetic resonance imaging disappeared, and neurological symptoms improved. After resuming durvalumab, he became unable to walk due to neurological adverse events (nAEs). There have been no reported cases manifesting PNSs and nAEs as a result of the same immune checkpoint inhibitors (ICIs) administered at different times. Resuming ICIs in patients diagnosed with PNSs should be performed with prudence.
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Affiliation(s)
- Tomokazu Seki
- Department of Neurology, Faculty of Medicine, University of Toyama, Japan
| | - Kousuke Baba
- Department of Neurology, Faculty of Medicine, University of Toyama, Japan
| | - Tomohiro Hayashi
- Department of Neurology, Faculty of Medicine, University of Toyama, Japan
| | - Risako Furuta
- Department of Neurology, Faculty of Medicine, University of Toyama, Japan
| | - Hiroaki Hirosawa
- Department of Neurology, Faculty of Medicine, University of Toyama, Japan
| | - Taichi Mitsui
- Department of Neurology, Faculty of Medicine, University of Toyama, Japan
| | - Hiroki Maesaka
- Department of Neurology, Faculty of Medicine, University of Toyama, Japan
| | - Syuhei Takasawa
- Department of Neurology, Faculty of Medicine, University of Toyama, Japan
| | - Toshiro Miwa
- First Department of Internal Medicine, Toyama University Hospital, Japan
| | - Keiko Tanaka
- Department of Animal Model Development, Bioresource Science Branch, Center for Bioresource-based Research, Brain Research Institute, Niigata University, Japan
| | - Yuji Nakatsuji
- Department of Neurology, Faculty of Medicine, University of Toyama, Japan
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Otis SU, Banna GL, Maniam A. The association between paraneoplastic neurological syndromes (PNS) and urothelial carcinoma - A review of the literature. Crit Rev Oncol Hematol 2024; 196:104314. [PMID: 38447785 DOI: 10.1016/j.critrevonc.2024.104314] [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: 11/04/2023] [Revised: 02/10/2024] [Accepted: 02/26/2024] [Indexed: 03/08/2024] Open
Abstract
Paraneoplastic neurological syndromes (PNS) are rare neurological disorders arising from malignancy-triggered autoimmunity, yet their association with urothelial carcinoma remains unclear. This systematic review intends to explore any connection, alongside patient/clinical features and management. A literature search identified 25 cases of bladder and upper tract carcinoma linked to PNS. Overall, while infrequent, a meaningful association between PNS and urothelial carcinoma was found in that 84% of cases met a 'possible'-or-'higher-likelihood' PNS diagnosis. Most cases presented with high-risk PNS phenotypes, predominantly cerebellar syndromes and encephalomyelitis/sensory neuronopathy, ∼17 months within cancer diagnosis/recurrence. Review findings suggest a female preponderance in suspected PNS despite higher male incidence of urothelial cancer. Main treatments consisted of surgery alongside chemotherapy or immunotherapeutics (IVIG and/or corticosteroids), which improved symptoms for a slight majority (60%). Ultimately, while common PNS-associated neoplasms should always first be excluded in suspected PNS, in the absence of alternative causes, urothelial carcinomas do merit clinical consideration.
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Affiliation(s)
- Sarafina Urenna Otis
- Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Oxford, England OX3 9DU, UK
| | - Giuseppe Luigi Banna
- Portsmouth Hospitals University NHS Trust, Portsmouth, England PO6 3LY, UK; Faculty of Science and Health, School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, England PO1 2UP, UK
| | - Akash Maniam
- Portsmouth Hospitals University NHS Trust, Portsmouth, England PO6 3LY, UK; Caribbean Cancer Research Institute, Chanka Trace El Socorro South, Trinidad and Tobago.
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10
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Nassar AH, El Zarif T, Khalid AB, Rahme S, Zhong C, Kwak L, Salame M, Farhat EB, Freeman D, El-Am E, Ravishankar A, Ahmad B, Nana FA, Kaldas D, Naqash AR, Sharon E, LeBoeuf NR, Cortellini A, Malgeri A, Gupta S, Al-Hader A, Sparks JA, Linnoila J, Hamnvik OPR, Mouhieddine TH, Marron T, Parikh K, McKay RR, Dilling T, Choueiri TK, Adib E, Najem E, Kim SY, Sonpavde G. Clinical outcomes and safety of immune checkpoint inhibitors in patients with solid tumors and paraneoplastic syndromes. J Immunother Cancer 2024; 12:e008724. [PMID: 38448038 PMCID: PMC10916116 DOI: 10.1136/jitc-2023-008724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Patients with paraneoplastic syndromes (PNS) are excluded from clinical trials involving immune checkpoint inhibitors (ICIs) due to safety concerns. Moreover, real-world data on efficacy and safety is scarce. METHODS In this retrospective study, data were collected on patients with PNS and solid tumors receiving ICI between 2015 and 2022 at nine institutions. Patients were classified into: Cohort 1 (pre-existing PNS before ICI initiation), cohort 2 (PNS during ICI treatment), and cohort 3 (PNS after ICI discontinuation). Patients with metastatic non-small cell lung cancer (NSCLC) (mNSCLC) from cohort 1 were matched to patients who were PNS-free at each institution up to a 1:3 ratio for age, sex, type of ICI, use of concurrent chemotherapy, and number of lines of systemic therapy prior to ICI initiation. Kaplan-Meier method was used to assess overall survival (OS) and time-to-next treatment (TTNT). RESULTS Among 109 patients with PNS treated with ICIs, median age at ICI initiation was 67 years (IQR: 58-74). The most represented cancer type was NSCLC (n=39, 36%). In cohort 1 (n=55), PNS exacerbations occurred in 16 (29%) patients with median time to exacerbation after ICI of 1.1 months (IQR: 0.7-3.3). Exacerbation or de novo PNS prompted temporary/permanent interruption of ICIs in 14 (13%) patients. For cohort 2 (n=16), median time between ICI initiation and de novo PNS was 1.2 months (IQR: 0.4-3.5). Treatment-related adverse events (trAEs) occurred in 43 (39%) patients. Grade ≥3 trAEs occurred in 18 (17%) patients. PNS-directed immunosuppressive therapy was required in 55 (50%) patients. We matched 18 patients with mNSCLC and PNS (cohort 1) to 40 without PNS, treated with ICIs. There was no significant difference in OS or TTNT between patients with mNSCLC with and without PNS, although a trend was seen towards worse outcomes in patients with PNS. TrAEs occurred in 6/18 (33%) and 14/40 (35%), respectively. Grade ≥3 trAEs occurred in 4 (22%) patients with PNS and 7 (18%) patients without PNS. CONCLUSIONS Exacerbations of pre-existing PNS occurred in 29% of patients treated with ICIs and both exacerbations and de novo PNS occur early in the ICI course. TrAE from ICIs were similar between patients with and without PNS. Our data suggest that pre-existing PNS should not preclude consideration of ICI therapy although patients may not derive the same clinical benefit compared with patients without PNS.
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Affiliation(s)
| | - Talal El Zarif
- Yale University, New Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ahmed Bilal Khalid
- Indiana Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
| | - Serena Rahme
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, New York, USA
| | - Caiwei Zhong
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lucia Kwak
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Elias Bou Farhat
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Dory Freeman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Arjun Ravishankar
- Yale University, New Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Bachar Ahmad
- Yale University, New Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Frank Aboubakar Nana
- Division of Pneumology, CHU UCL Namur, Yvoir, Namur, Belgium
- Division of Pneumology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - David Kaldas
- Department of Internal Medicine, University of South Florida, Tampa, Florida, USA
- Department of Clinical Oncology, Cairo University, Giza, Egypt
| | - Abdul Rafeh Naqash
- Medical Oncology/TSET Phase 1 Program, The University of Oklahoma Stephenson Cancer Center, Oklahoma City, Oklahoma, USA
| | - Elad Sharon
- National Cancer Institute, Bethesda, Maryland, USA
| | | | - Alessio Cortellini
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Andrea Malgeri
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Shruti Gupta
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ahmad Al-Hader
- Indiana Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
| | | | - Jenny Linnoila
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - Thomas Marron
- Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Rana R McKay
- Division of Medical Oncology, University of California San Diego, La Jolla, California, USA
| | - Thomas Dilling
- Department of Internal Medicine, University of South Florida, Tampa, Florida, USA
| | - Toni K Choueiri
- Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, UK
| | - Elio Adib
- Harvard Medical School, Boston, Massachusetts, USA
| | - Elie Najem
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
| | - So Yeon Kim
- Yale University, New Haven, Connecticut, USA
| | - Guru Sonpavde
- Medical Oncology, AdventHealth Central Florida, Orlando, Florida, USA
- AdventHealth Cancer Institute, AdventHealth, Altamonte Springs, Florida, USA
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11
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Norrito RL, Puleo MG, Pintus C, Basso MG, Rizzo G, Di Chiara T, Di Raimondo D, Parrinello G, Tuttolomondo A. Paraneoplastic Cerebellar Degeneration Associated with Breast Cancer: A Case Report and a Narrative Review. Brain Sci 2024; 14:176. [PMID: 38391750 PMCID: PMC10887192 DOI: 10.3390/brainsci14020176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/23/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
Paraneoplastic neurological syndromes (PNSs) are an uncommon complication of cancer, affecting nearby 1/10,000 subjects with a tumour. PNSs can involve all the central and peripheral nervous systems, the muscular system, and the neuromuscular junction, causing extremely variable symptomatology. The diagnosis of the paraneoplastic disease usually precedes the clinical manifestations of cancer, making an immediate recognition of the pathology crucial to obtain a better prognosis. PNSs are autoimmune diseases caused by the expression of common antigens by the tumour and the nervous system. Specific antibodies can help clinicians diagnose them, but unfortunately, they are not always detectable. Immunosuppressive therapy and the treatment of cancer are the cornerstones of therapy for PNSs. This paper reports a case of PNSs associated with breast tumours and focuses on the most common paraneoplastic neurological syndromes. We report a case of a young female with a clinical syndrome of the occurrence of rigidity in the right lower limb with postural instability with walking supported and diplopia, with a final diagnosis of paraneoplastic cerebellar degeneration and seronegative rigid human syndrome associated with infiltrating ductal carcinoma of the breast.
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Affiliation(s)
- Rosario Luca Norrito
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Maria Grazia Puleo
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Chiara Pintus
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Maria Grazia Basso
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Giuliana Rizzo
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Tiziana Di Chiara
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Domenico Di Raimondo
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Gaspare Parrinello
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Antonino Tuttolomondo
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
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12
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Holroyd KB, Berkowitz AL. Metabolic and Toxic Myelopathies. Continuum (Minneap Minn) 2024; 30:199-223. [PMID: 38330479 DOI: 10.1212/con.0000000000001376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE This article reviews the clinical presentation, diagnostic evaluation, and treatment of metabolic and toxic myelopathies resulting from nutritional deficiencies, environmental and dietary toxins, drugs of abuse, systemic medical illnesses, and oncologic treatments. LATEST DEVELOPMENTS Increased use of bariatric surgery for obesity has led to higher incidences of deficiencies in nutrients such as vitamin B12 and copper, which can cause subacute combined degeneration. Myelopathies secondary to dietary toxins including konzo and lathyrism are likely to become more prevalent in the setting of climate change leading to drought and flooding. Although modern advances in radiation therapy techniques have reduced the incidence of radiation myelopathy, patients with cancer are living longer due to improved treatments and may require reirradiation that can increase the risk of this condition. Immune checkpoint inhibitors are increasingly used for the treatment of cancer and are associated with a wide variety of immune-mediated neurologic syndromes including myelitis. ESSENTIAL POINTS Metabolic and toxic causes should be considered in the diagnosis of myelopathy in patients with particular clinical syndromes, risk factors, and neuroimaging findings. Some of these conditions may be reversible if identified and treated early, requiring careful history, examination, and laboratory and radiologic evaluation for prompt diagnosis.
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13
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Verma N, Jaffer MH, Kolli AS, Mokhtari S. Updates in the Management of Paraneoplastic Syndrome. Semin Neurol 2024; 44:36-46. [PMID: 38183975 DOI: 10.1055/s-0043-1777353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2024]
Abstract
Paraneoplastic neurological syndromes (PNS) are defined as remote neurologic immune-mediated effects triggered by underlying systemic tumors. While recognizing specific syndromes can aid early cancer detection, overutilization of paraneoplastic assays in the absence of a classic syndrome can precipitate overdiagnosis and overtreatment. PNS involve autoantibodies targeting intracellular or extracellular antigens, with variable immunotherapy responses based on antigen type. Diagnosing PNS is challenging, requiring exclusion of other differential diagnoses. New diagnostic criteria classify PNS into high-risk and intermediate-risk phenotypes based on clinical phenotype, neuronal antibodies, and cancer presence. Patients with cell surface antibodies respond better to immunotherapies compared to those with intracellular antigen targets. Understanding PNS syndromes, serological markers, and oncological features guides management, which facilitates initiation of immunosuppression for PNS alongside treatment of the underlying neoplasm, thereby improving neurologic and oncologic outcomes. Initial treatments often include intravenous methylprednisolone, plasma exchange, or intravenous immunoglobulins. Second-line immunosuppressants like rituximab or cyclophosphamide may be necessary if initial treatments fail. Specific therapies vary based on antibody target. Here, we summarize the current approach to the investigation, diagnosis, and treatment of patients with suspected PNS.
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Affiliation(s)
- Neha Verma
- Department of Internal Medicine, Moffitt Cancer Center, Tampa, Florida
| | | | - Avinash S Kolli
- Department of Neurology, University of South Florida, Tampa, Florida
| | - Sepideh Mokhtari
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, Florida
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14
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Farina A, Villagrán-García M, Vogrig A, Zekeridou A, Muñiz-Castrillo S, Velasco R, Guidon AC, Joubert B, Honnorat J. Neurological adverse events of immune checkpoint inhibitors and the development of paraneoplastic neurological syndromes. Lancet Neurol 2024; 23:81-94. [PMID: 38101905 DOI: 10.1016/s1474-4422(23)00369-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 12/17/2023]
Abstract
Immune checkpoint inhibitors, a class of oncological treatments that enhance antitumour immunity, can trigger neurological adverse events closely resembling paraneoplastic neurological syndromes. Unlike other neurological adverse events caused by these drugs, post-immune checkpoint inhibitor paraneoplastic neurological syndromes predominantly affect the CNS and are associated with neural antibodies and cancer types commonly found also in spontaneous paraneoplastic neurological syndromes. Furthermore, post-immune checkpoint inhibitor paraneoplastic neurological syndromes have poorer neurological outcomes than other neurological adverse events of immune checkpoint inhibitors. Early diagnosis and initiation of immunosuppressive therapy are likely to be crucial in preventing the accumulation of neurological disability. Importantly, the neural antibodies found in patients with post-immune checkpoint inhibitor paraneoplastic neurological syndromes are sometimes detected before treatment, indicating that these antibodies might help to predict the development of neurological adverse events. Experimental and clinical evidence suggests that post-immune checkpoint inhibitor paraneoplastic neurological syndromes probably share immunological features with spontaneous paraneoplastic syndromes. Hence, the study of post-immune checkpoint inhibitor paraneoplastic neurological syndromes can help in deciphering the immunopathogenesis of paraneoplastic neurological syndromes and in identifying novel therapeutic targets.
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Affiliation(s)
- Antonio Farina
- Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Neurological Hospital, Bron, France; MeLiS, UCBL-CNRS UMR 5284, INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France; Department of Neuroscience, Psychology, Pharmacology and Child Health, University of Florence, Florence, Italy
| | - Macarena Villagrán-García
- Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Neurological Hospital, Bron, France; MeLiS, UCBL-CNRS UMR 5284, INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
| | - Alberto Vogrig
- Clinical Neurology, Santa Maria della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy; Department of Medicine (DAME), University of Udine Medical School, Udine, Italy
| | - Anastasia Zekeridou
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Sergio Muñiz-Castrillo
- Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Neurological Hospital, Bron, France; MeLiS, UCBL-CNRS UMR 5284, INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France; Stanford Center for Sleep Sciences and Medicine, Palo Alto, CA, USA
| | - Roser Velasco
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-Institut Català d Oncologia L'Hospitalet, Institut d'Investigació Biomèdica de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain; Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Amanda C Guidon
- Harvard Medical School, Boston, MA, USA; Division of Neuromuscular Medicine, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Bastien Joubert
- Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Neurological Hospital, Bron, France; MeLiS, UCBL-CNRS UMR 5284, INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France; Department of Neurology, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Jérôme Honnorat
- Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Neurological Hospital, Bron, France; MeLiS, UCBL-CNRS UMR 5284, INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France.
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15
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Briani C, Visentin A. Hematologic malignancies and hematopoietic stem cell transplantation. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:419-429. [PMID: 38494294 DOI: 10.1016/b978-0-12-823912-4.00016-5] [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
Paraneoplastic neurologic syndromes are rarely associated with hematologic malignancies. In their rarity, lymphomas are the diseases with more frequent paraneoplastic neurologic syndrome. High-risk antibodies are absent in most lymphoma-associated paraneoplastic neurologic syndromes, with the exception of antibodies to Tr/DNER in paraneoplastic cerebellar degeneration, mGluR5 in limbic encephalitis, and mGluR1 in some cerebellar ataxias. Peripheral nervous system paraneoplastic neurologic syndromes are rare and heterogeneous, with a prevalence of demyelinating polyradiculoneuropathy in non-Hodgkin lymphoma. Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changes (POEMS) is a rare, paraneoplastic syndrome due to an underlying plasma cell disorder. The diagnosis is based on defined criteria, and vascular endothelial growth factor (VEGF), not an antibody, is considered a reliable diagnostic marker that also mirrors therapy response. As with the paraneoplastic neurologic syndromes in solid tumors, therapies rely on cancer treatment associated with immunomodulatory treatment with better response in PNS with antibodies to surface antigens. The best outcome is generally present in Ophelia syndrome/limbic encephalitis with anti-mGluR5 antibodies, with frequent complete recovery. Besides patients with isolated osteosclerotic lesions (where radiotherapy is indicated), hematopoietic stem-cell transplantation is the therapy of choice in patients with POEMS syndrome. In the paraneoplastic neurologic syndromes secondary to immune checkpoint inhibitors, discontinuation of the drug together with immunomodulatory treatment is recommended.
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Affiliation(s)
- Chiara Briani
- Department of Neurosciences, Neurology Unit, University of Padova, Padova, Italy.
| | - Andrea Visentin
- Department of Medicine, Hematology Unit, University of Padova, Padova, Italy
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16
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Dalmau J. Changing landscape in the field of paraneoplastic neurology: Personal perspectives over a 35-year career. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:11-32. [PMID: 38494272 DOI: 10.1016/b978-0-12-823912-4.00013-x] [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
Paraneoplastic neurologic syndromes are a group of rare disorders that have fascinated neurologists for more than a century. The discovery in the 1980s that many of these disorders occurred in association with antibodies against neuronal proteins revived the interest for these diseases. This chapter first traces the history of the paraneoplastic neurologic syndromes during the era that preceded the discovery of immune mechanisms and then reviews the immunologic period during which many of these syndromes were found to be associated with antibodies against intracellular onconeuronal proteins and pathogenic cytotoxic T-cell mechanisms. Alongside these developments, investigations on the antibody-mediated disorders of the peripheral nervous system, such as the myasthenic syndromes or neuromyotonia, provided suggestions for the study of the central nervous system (CNS) syndromes. These converging areas of research culminated with the groundbreaking discovery of a new category of CNS disorders mediated by antibodies against neuronal surface proteins or receptors. These disorders are not always paraneoplastic, and the understanding of these syndromes and mechanisms has changed the landscape of neurology and neurosciences.
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Affiliation(s)
- Josep Dalmau
- IDIBAPS-Hospital Clinic, University of Barcelona, Barcelona, Spain; Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain.
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17
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Quinot V, Höftberger R. Pathogenesis and immunopathology of paraneoplastic disorders. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:33-54. [PMID: 38494287 DOI: 10.1016/b978-0-12-823912-4.00027-x] [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
Paraneoplastic neurologic syndromes (PNS) represent a rare group of immune-mediated complications associated with an underlying tumor. Ectopic protein expression in neoplastic cells or an aberrant immune regulation in the course of hematooncologic diseases or thymomas trigger an autoimmune response that may affect any part of the central and/or peripheral nervous system. Recent advances in drug therapies as well as novel animal models and neuropathologic studies have led to further insights on the immune pathomechanisms of PNS. Although the syndromes share common paths in pathogenesis, they may differ in the disease course, prognosis, and therapy targets, depending on the localization and type of antibody epitope. Neuropathologic hallmarks of PNS associated with antibodies directed against intracellular epitopes are characterized by T cell-dominated inflammation, reactive gliosis including microglial nodules, and neuronal degeneration. By contrast, the neuropathology of cell surface antibody-mediated PNS strongly depends on the targeted antigen and varies from B cell/plasma cell-dominated inflammation and well-preserved neurons together with a reduced expression of the target antigen in anti-NMDAR encephalitis to irreversible Purkinje cell loss in anti-P/Q-type VGCC antibody-associated paraneoplastic cerebellar degeneration. The understanding of different pathomechanisms in PNS is important because they strongly correspond with therapy response and prognosis, and should guide treatment decisions.
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Affiliation(s)
- Valérie Quinot
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Romana Höftberger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria.
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18
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Kerstens J, Titulaer MJ. Overview of treatment strategies in paraneoplastic neurological syndromes. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:97-112. [PMID: 38494299 DOI: 10.1016/b978-0-12-823912-4.00015-3] [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
Treatment strategies in paraneoplastic neurological syndromes rely on the three pillars of tumor treatment, immunotherapy, and symptomatic treatment, the first one being by far the most important in the majority of patients and syndromes. Classically, antibodies against extracellular antigens are directly pathogenic, and patients with these syndromes are more responsive to immunomodulatory or immunosuppressive treatments than the ones with antibodies against intracellular targets. This chapter first discusses some general principles of tumor treatment and immunotherapy, followed by a closer look at specific treatment options for different clinical syndromes, focusing on symptomatic treatments.
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Affiliation(s)
- Jeroen Kerstens
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maarten J Titulaer
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands.
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19
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Montalvo M, Flanagan EP. Paraneoplastic/autoimmune myelopathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:193-201. [PMID: 38494277 DOI: 10.1016/b978-0-12-823912-4.00017-7] [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
Paraneoplastic myelopathies are a rare but important category of myelopathy. They usually present with an insidious or subacute progressive neurologic syndrome. Risk factors include tobacco use and family history of cancer. Cerebrospinal fluid analysis usually shows lymphocytic pleocytosis with elevated protein. MRI findings suggest that paraneoplastic myelopathies include longitudinally extensive T2 hyperintensities that are tract-specific and accompanied by enhancement, but spinal MRIs can also be normal. The most commonly associated neural antibodies include amphiphysin and collapsin-response-mediator-protein-5 (CRMP5/anti-CV2) antibodies with lung and breast cancers being the most frequent oncologic accompaniments. The differential diagnosis of paraneoplastic myelopathies includes nutritional deficiency myelopathy (B12, copper) as well as autoimmune/inflammatory conditions such as primary progressive multiple sclerosis or spinal cord sarcoidosis. Patients treated with immune checkpoint inhibitors for cancer may develop myelitis, that can be considered along the spectrum of paraneoplastic myelopathies. Management of paraneoplastic myelopathy includes oncologic treatment and immunotherapy. Despite these treatments, the prognosis is poor and the majority of patients eventually become wheelchair-dependent.
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Affiliation(s)
- Mayra Montalvo
- Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, MN, United States; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States.
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Sato Y, Fujiwara S, Hata A, Kida Y, Masuda T, Amimoto H, Matsumoto H, Miyoshi K, Otsuka K, Tomii K. Clinical Impact of Pre-Existing Autoantibodies in Patients With SCLC Treated With Immune Checkpoint Inhibitor: A Multicenter Prospective Observational Study. JTO Clin Res Rep 2023; 4:100608. [PMID: 38162177 PMCID: PMC10755358 DOI: 10.1016/j.jtocrr.2023.100608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/15/2023] [Accepted: 11/15/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Although pretreatment autoantibodies have been associated with immune-related adverse events (irAEs) and immune checkpoint inhibitor treatment efficacy in some types of cancer, their importance has not been evaluated in patients with SCLC. Methods A multicenter prospective observational study was conducted on a total of 52 patients with extensive-disease SCLC who received immune checkpoint inhibitors in combination with chemotherapy as the first-line treatment at either of the six participating centers in Japan. Pretreatment serum samples were collected and analyzed for autoantibodies (rheumatoid factor, antinuclear antibodies, and antithyroid). Moreover, 12 antineuronal antibodies (AMPH, CV2, PNMA2, Ri, Yo, Hu, Recoverin, SOX1, Titin, Zic4, GAD65, and Tr) were analyzed using immunoblot assays. The primary end point was the incidence of irAEs with or without autoantibodies. The secondary end points were progression-free survival (PFS) and overall survival (OS) on the basis of the presence or absence of autoantibodies. Results PFS and OS were 4.4 and 25.3 months, respectively. Autoantibodies (rheumatoid factor, antinuclear antibodies, and antithyroid antibodies) were detected in 29 patients (56%). In total, irAEs were observed in 18 patients (35%); irAE incidence was 48% in the autoantibody-positive group and 17% in the autoantibody-negative group (p = 0.039). There was no difference in PFS or OS between patients with and without autoantibodies (4.4 mo versus 4.6 mo, p = 0.36; 15.3 mo versus 18.2 mo, p = 0.36). Antineuronal antibodies were detected in 16 patients (31%). However, the development of neurologic irAEs was not observed in both groups. Conclusions Vigilance is required against the development of irAEs in pretreatment antibody-positive patients.
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Affiliation(s)
- Yuki Sato
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Satoru Fujiwara
- Department of Neurology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Akito Hata
- Department of Thoracic Oncology, Kobe Minimally Invasive Cancer Center, Kobe, Japan
| | - Yoko Kida
- Department of Respiratory Medicine, Kobe City Nishi-Kobe Medical Center, Kobe, Japan
| | - Takahiro Masuda
- Department of Respiratory Medicine, Kobe City Nishi-Kobe Medical Center, Kobe, Japan
| | - Hisanori Amimoto
- Department of Respiratory Medicine, Kobe City Medical Center West Hospital, Kobe, Japan
| | - Hirotaka Matsumoto
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Kotoko Miyoshi
- Department of Respiratory Medicine, Shinko Hospital, Kobe, Japan
| | - Kojiro Otsuka
- Department of Respiratory Medicine, Shinko Hospital, Kobe, Japan
| | - Keisuke Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
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21
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Vogrig A, Pegat A, Villagrán-García M, Wucher V, Attignon V, Sohier E, Brevet M, Rogemond V, Pinto AL, Muñiz-Castrillo S, Peter E, Robert M, Picard G, Hopes L, Psimaras D, Terra A, Perrin C, Cogne D, Tabone-Eglinger S, Martinez S, Jury D, Valantin J, Gadot N, Auclair-Perrossier J, Viari A, Dubois B, Desestret V, Honnorat J. Different Genetic Signatures of Small-Cell Lung Cancer Characterize Anti-GABA B R and Anti-Hu Paraneoplastic Neurological Syndromes. Ann Neurol 2023; 94:1102-1115. [PMID: 37638563 DOI: 10.1002/ana.26784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/27/2023] [Accepted: 08/24/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE Small-cell lung cancer (SCLC) is the malignancy most frequently associated with paraneoplastic neurological syndromes (PNS) and can trigger different antibody responses against intracellular (Hu) or neuronal surface (GABAB R) antigens. Our aim was to clarify whether the genomic and transcriptomic features of SCLC are different in patients with anti-GABAB R or anti-Hu PNS compared with SCLC without PNS. METHODS A total of 76 SCLC tumor samples were collected: 34 anti-Hu, 14 anti-GABAB R, and 28 SCLC without PNS. The study consisted of 4 steps: (1) pathological confirmation; (2) next generation sequencing using a panel of 98 genes, including those encoding the autoantibodies targets ELAVL1-4, GABBR1-2, and KCTD16; (3) genome-wide copy number variation (CNV); and (4) whole-transcriptome RNA sequencing. RESULTS CNV analysis revealed that patients with anti-GABAB R PNS commonly have a gain in chromosome 5q, which contains KCTD16, whereas anti-Hu and control patients often harbor a loss. No significantly different number of mutations regarding any onconeural genes was observed. Conversely, the transcriptomic profile of SCLC was different, and the differentially expressed genes allowed effective clustering of the samples into 3 groups, reflecting the antibody-based classification, with an overexpression of KCTD16 specific to anti-GABAB R PNS. Pathway analysis revealed that tumors of patients with anti-GABAB R encephalitis were enriched in B-cell signatures, as opposed to those of patients with anti-Hu, in which T-cell- and interferon-γ-related signatures were overexpressed. INTERPRETATION SCLC genetic and transcriptomic features differentiate anti-GABAB R, anti-Hu, and non-PNS tumors. The role of KCTD16 appears to be pivotal in the tumor immune tolerance breakdown of anti-GABAB R PNS. ANN NEUROL 2023;94:1102-1115.
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Affiliation(s)
- Alberto Vogrig
- French Reference Center of Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- Mechanisms in integrated life sciences Institute, (MeLiS), INSERM U1314, CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Clinical Neurology, Santa Maria della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Antoine Pegat
- Service ENMG et Pathologies Neuromusculaires, Hôpital Neurologique P. Wertheimer, Hospices Civils de Lyon, Bron, France
- Pathophysiology and Genetics of Neuron and Muscle, CNRS UMR 5261, INSERM U1315, INMG, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, Lyon, France
| | - Macarena Villagrán-García
- French Reference Center of Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- Mechanisms in integrated life sciences Institute, (MeLiS), INSERM U1314, CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Valentin Wucher
- French Reference Center of Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- Mechanisms in integrated life sciences Institute, (MeLiS), INSERM U1314, CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Valéry Attignon
- Cancer Genomic Platform, Cancer Research Center of Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS, Centre Léon Bérard, Lyon, France
| | - Emilie Sohier
- Gilles Thomas Bioinformatics Platform, Cancer Research Center of Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS, Centre Léon Bérard, Lyon, France
- Fondation Synergie Lyon Cancer, Centre Léon Bérard, Lyon, France
| | - Marie Brevet
- Department of Pathology, Lyon Est Hospital, Hospices Civils de Lyon, Bron, France
| | - Veronique Rogemond
- French Reference Center of Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- Mechanisms in integrated life sciences Institute, (MeLiS), INSERM U1314, CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Anne-Laurie Pinto
- French Reference Center of Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- Mechanisms in integrated life sciences Institute, (MeLiS), INSERM U1314, CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Sergio Muñiz-Castrillo
- French Reference Center of Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- Mechanisms in integrated life sciences Institute, (MeLiS), INSERM U1314, CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Stanford Center for Sleep Sciences and Medicine, Stanford University, Palo Alto, CA, USA
| | - Elise Peter
- French Reference Center of Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- Mechanisms in integrated life sciences Institute, (MeLiS), INSERM U1314, CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Melisse Robert
- French Reference Center of Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- Mechanisms in integrated life sciences Institute, (MeLiS), INSERM U1314, CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Géraldine Picard
- French Reference Center of Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- Mechanisms in integrated life sciences Institute, (MeLiS), INSERM U1314, CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Lucie Hopes
- Department of Neurology, CHRU Nancy, Nancy, France
| | - Dimitri Psimaras
- Neurology 2 Department Mazarin, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Sorbonne Université, INSERM, CNRS, Paris Brain Institute, Institut du Cerveau et de la Moelle Épinière, ICM, Paris, France
| | - Anthony Terra
- Centre de Ressources Biologiques Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
| | - Corinne Perrin
- Centre de Ressources Biologiques Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
| | - Dominique Cogne
- Plateforme de Gestion des Echantillons Biologique, Cancer Research Center of Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS, Centre Léon Bérard, Lyon, France
| | - Severine Tabone-Eglinger
- Plateforme de Gestion des Echantillons Biologique, Cancer Research Center of Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS, Centre Léon Bérard, Lyon, France
| | - Séverine Martinez
- Plateforme de Gestion des Echantillons Biologique, Cancer Research Center of Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS, Centre Léon Bérard, Lyon, France
| | - Delphine Jury
- Plateforme de Gestion des Echantillons Biologique, Cancer Research Center of Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS, Centre Léon Bérard, Lyon, France
| | - Julie Valantin
- Plateforme Anatomopathologie Recherche, Cancer Research Center of Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS Centre Léon Bérard, Lyon, France
| | - Nicolas Gadot
- Plateforme Anatomopathologie Recherche, Cancer Research Center of Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS Centre Léon Bérard, Lyon, France
| | - Jessie Auclair-Perrossier
- Cancer Genomic Platform, Cancer Research Center of Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS, Centre Léon Bérard, Lyon, France
| | - Alain Viari
- Gilles Thomas Bioinformatics Platform, Cancer Research Center of Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS, Centre Léon Bérard, Lyon, France
| | - Bertrand Dubois
- Cancer Immune Surveillance and Therapeutic Targeting Team, Cancer Research Center of Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS, Centre Léon Bérard, Lyon, France
- Lyon Immunotherapy for Cancer Laboratory, Cancer Research Center of Lyon, Lyon, France
| | - Virginie Desestret
- French Reference Center of Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- Mechanisms in integrated life sciences Institute, (MeLiS), INSERM U1314, CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Jérôme Honnorat
- French Reference Center of Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- Mechanisms in integrated life sciences Institute, (MeLiS), INSERM U1314, CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
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22
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Li EC, Lai QL, Cai MT, Fang GL, Shen CH, Ding MP, Zhang YX. Anti-adenylate kinase 5 encephalitis: Clinical characteristics, diagnosis, and management of this rare entity. J Transl Autoimmun 2023; 7:100218. [PMID: 37859804 PMCID: PMC10582738 DOI: 10.1016/j.jtauto.2023.100218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/08/2023] [Accepted: 10/06/2023] [Indexed: 10/21/2023] Open
Abstract
The spectrum and understanding of antibody-positive autoimmune encephalitis (AE) have expanded over the past few decades. In 2007, a rare subtype of AE known as anti-adenylate kinase 5 (AK5) encephalitis, was first reported. This disease is more common in elderly males, with limbic encephalitis as the core phenotype (characterized by subacute anterograde amnesia, sometimes with psychiatric symptoms, and rarely with seizures). Brain magnetic resonance imaging typically demonstrated initial temporal lobe T2/fluid-attenuated inversion recovery hyperintensities, and subsequent atrophy. No concomitant tumors have been found yet. AK5 antibody, targeting the intracellular antigen, is a biomarker for a non-paraneoplastic T-cell autoimmunity response, and can be detected in serum and cerebrospinal fluid using tissue-based and cell-based assays. Cytotoxic T-cell-mediating neuronal injury and loss play a pivotal role in the immunopathogenesis of anti-AK5 encephalitis. Patients mostly show poor response to immunotherapy and thus a poor prognosis in the long run. Herein, we review the literature and provide updated knowledge of this less-known entity, focusing on clinical characteristics, paraclinical findings, diagnosis process, and therapeutic approaches.
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Affiliation(s)
- Er-Chuang Li
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
- Department of Neurology, Taikang Ningbo Hospital, Ningbo, 315042, China
| | - Qi-Lun Lai
- Department of Neurology, Zhejiang Hospital, Hangzhou, 310013, China
| | - Meng-Ting Cai
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Gao-Li Fang
- Department of Neurology, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, 310003, China
| | - Chun-Hong Shen
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Mei-Ping Ding
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Yin-Xi Zhang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
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23
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Fonseca E, Cabrera-Maqueda JM, Ruiz-García R, Naranjo L, Diaz-Pedroche C, Velasco R, Macias-Gómez A, Milisenda JC, Muñoz-Farjas E, Pascual-Goñi E, Gállego Perez-Larraya J, Saiz A, Dalmau J, Blanco Y, Graus F, Martinez-Hernandez E. Neurological adverse events related to immune-checkpoint inhibitors in Spain: a retrospective cohort study. Lancet Neurol 2023; 22:1150-1159. [PMID: 37977714 DOI: 10.1016/s1474-4422(23)00335-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/07/2023] [Accepted: 08/31/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Neurological immune-related adverse events associated with immune checkpoint inhibitors can have several clinical manifestations, but the syndromes and prognostic factors are still not well known. We aimed to characterise and group the clinical features, with a special focus in patients presenting with encephalopathy, and to identify predictors of response to therapy and survival. METHODS This retrospective observational study included patients with neurological immune-related adverse events from 20 hospitals in Spain whose clinical information, serum samples, and CSF samples were studied at Hospital Clinic de Barcelona, Barcelona, Spain. Patients with pre-existing paraneoplastic syndromes or evidence of alternative causes for their neurological symptoms were excluded. We reviewed the clinical information, classified their clinical features, and determined the presence of neural antibodies. Neurological status was assessed by the treating physician one month after adverse event onset (as improvement vs no improvement) and at the last evaluation (complete recovery or modified Rankin Scale score decrease of at least 2 points, indicating good outcome, vs all other modified Rankin Scale scores, indicating poor outcome); if the participant had died, the date and cause of death were recorded. We used Fisher's exact tests and Mann-Whitney U tests to analyse clinical features, and multivariable logistic regression to analyse prognostic factors. FINDINGS From Jan 1, 2018, until Feb 1, 2023, 83 patients with suspected neurological immune-related adverse events after use of immune checkpoint inhibitors were identified, of whom 64 patients were included. These patients had a median age of 67 years (IQR 59-74); 42 (66%) were male and 22 (34%) were female. The predominant tumours were lung cancer (30 [47%] patients), melanoma (13 [21%] patients), and renal cell carcinoma (seven [11%] patients). Neural antibodies were detected in 14 (22%) patients; 52 (81%) patients had CNS involvement and 12 (19%) had peripheral nervous system involvement. Encephalopathy occurred in 45 (70%) patients, 12 (27%) of whom had antibodies or well defined syndromes consistent with definite paraneoplastic or autoimmune encephalitis, 24 (53%) of whom had encephalitis without antibodies or clinical features characteristic of a defined syndrome, and nine (20%) of whom had encephalopathy without antibodies or inflammatory changes in CSF or brain MRI. Nine (14%) of 64 patients had combined myasthenia and myositis, five of them with myocarditis. Even though 58 (91%) of 64 patients received steroids and 31 (48%) of 64 received additional therapies, 18 (28%) did not improve during the first month after adverse event onset, and 11 of these 18 people died. At the last follow-up for the 53 remaining patients (median 6 months, IQR 3-13), 20 (38%) had a poor outcome (16 deaths, one related to a neurological immune-related adverse event). Mortality risk was increased in patients with lung cancer (vs those with other cancers: HR 2·5, 95% CI 1·1-6·0) and in patients with encephalopathy without evidence of CNS inflammation or combined myocarditis, myasthenia, and myositis (vs those with the remaining syndromes: HR 5·0, 1·4-17·8 and HR 6·6, 1·4-31·0, respectively). INTERPRETATION Most neurological immune-related adverse events involved the CNS and were antibody negative. The presence of myocarditis, myasthenia, and myositis, of encephalopathy without inflammatory changes, or of lung cancer were independent predictors of death. Most deaths occurred during the first month of symptom onset. If our findings are replicated in additional cohorts, they could confirm that these patients need early and intensive treatment. FUNDING The Instituto de Salud Carlos III and the European Union.
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Affiliation(s)
- Elianet Fonseca
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Department of Neurology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jose M Cabrera-Maqueda
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Department of Neurology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Raquel Ruiz-García
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Department of Immunology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Laura Naranjo
- Department of Immunology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Carmen Diaz-Pedroche
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Roser Velasco
- Department of Neurology, Hospital Universitari de Bellvitge-Institut Catalàd'Oncologia, l'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Jose C Milisenda
- Department of Internal Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Elena Muñoz-Farjas
- Department of Neurology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Elba Pascual-Goñi
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona Spain
| | | | - Albert Saiz
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Department of Neurology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Josep Dalmau
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Department of Neurology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain; Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Yolanda Blanco
- Department of Neurology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Francesc Graus
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Eugenia Martinez-Hernandez
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Department of Neurology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.
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Hyun JW, Park NY, Kim MJ, Kim H, Kim KH, Kim SH, Kim HJ. Aquaporin-4-IgG positive neuromyelitis optica spectrum disorder in a paraneoplastic context. J Neurol Sci 2023; 454:120825. [PMID: 37813018 DOI: 10.1016/j.jns.2023.120825] [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: 08/07/2023] [Revised: 09/14/2023] [Accepted: 10/03/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE The association between aquaporin-4-immunoglobulin-G-positive neuromyelitis optica spectrum disorder (AQP4-IgG-NMOSD) and cancer via a plausible immunological response has been reported. Here, we investigated the frequency of cancer in a large cohort of patients with AQP4-IgG-NMOSD. METHODS Between May 2005 and January 2023, patients with AQP4-IgG-NMOSD and a history of cancer were included by searching for diagnostic codes of both NMOSD and cancer in the electronic medical records and/or reviewing the database of the National Cancer Center registry of inflammatory diseases of the central nervous system. Probable paraneoplastic AQP4-IgG-NMOSD was defined according to the 2021 Criteria for Paraneoplastic Neurological Syndrome. RESULTS Of 371 patients with AQP4-IgG-NMOSD, 23 (6.2%) had a history of cancer and four (1.1%) experienced NMOSD in a paraneoplastic context. Among the four patients with probable paraneoplastic AQP4-IgG-NMOSD, the types of cancer were lung (1 adenocarcinoma, 1 squamous cell carcinoma) and colorectal (2 adenocarcinomas). In three patients, the first NMOSD symptoms developed after a cancer diagnosis (median, 8 months [range, 4-23]), and one patient's symptoms preceded the cancer diagnosis (6 months). Compared to the 367 non-paraneoplastic patients, those in the paraneoplastic context had an older age at onset (median: 59.5 vs. 37 years, p = 0.012) and a higher proportion of longitudinally extensive transverse myelitis (LETM) as an initial manifestation (4/4[100%] vs. 130/367[35.4%], p = 0.017). CONCLUSIONS In a large cohort of patients with AQP4-IgG-NMOSD, the frequency of cancer was low. Older age, LETM features at onset, and adenocarcinoma as the histological type were usually observed in patients with AQP4-IgG-NMOSD in a paraneoplastic context.
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Affiliation(s)
- Jae-Won Hyun
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea
| | - Na Young Park
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea
| | - Min Jeong Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea
| | - Haeun Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea
| | - Ki Hoon Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea
| | - Su-Hyun Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea.
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25
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Akkus S, Elkhooly M, Amatya S, Shrestha K, Sharma K, Kagzi Y, Khan E, Gupta R, Piquet AL, Jaiswal S, Wen S, Tapia M, Samant R, Sista SR, Sriwastava S. Autoimmune and paraneoplastic neurological disorders: A review of relevant neuroimaging findings. J Neurol Sci 2023; 454:120830. [PMID: 37856996 DOI: 10.1016/j.jns.2023.120830] [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: 08/21/2023] [Revised: 09/28/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Paraneoplastic neurologic syndromes (PNS) and autoimmune encephalitis (AIE) are immune-mediated disorders. PNS is linked to cancer, while AIE may not Their clinical manifestations and imaging patterns need further elucidation. OBJECTIVE/AIMS To investigate the clinical profiles, antibody associations, neuroimaging patterns, treatments, and outcomes of PNS and AIE. METHODS A systematic review of 379 articles published between 2014 and 2023 was conducted. Of the 55 studies screened, 333 patients were diagnosed with either PNS or AIE and tested positive for novel antibodies. Data on demographics, symptoms, imaging, antibodies, cancer associations, treatment, and outcomes were extracted. RESULTS The study included 333 patients (mean age 54 years, 67% males) with PNS and AIE positive for various novel antibodies. 84% had central nervous system issues like cognitive impairment (53%), rhombencephalitis (17%), and cerebellar disorders (24%). Neuroimaging revealed distinct patterns with high-risk antibodies associated with brainstem lesions in 98%, cerebellar in 91%, hippocampal in 98%, basal ganglia in 75%, and spinal cord in 91%, while low/intermediate-risk antibodies were associated with medial temporal lobe lesions in 71% and other cortical/subcortical lesions in 55%. High-risk antibodies were associated with younger males, deep brain lesions, and increased mortality of 61%, while low/intermediate-risk antibodies were associated with females, cortical/subcortical lesions, and better outcomes with 39% mortality. Associated cancers included seminomas (23%), lung (19%), ovarian (2%), and breast (2%). Treatments included IVIG, chemotherapy, and plasmapheresis. Overall mortality was 25% in this cohort. CONCLUSION PNS and AIE have distinct clinical and radiological patterns based on antibody profiles. High-risk antibodies are associated with increased mortality while low/intermediate-risk antibodies are associated with improved outcomes. Appropriate imaging and antibody testing are critical for accurate diagnosis.
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Affiliation(s)
- Sema Akkus
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mahmoud Elkhooly
- Department of Neurology, Wayne state University, Detroit, MI, USA; Department of Neurology, Southern Illinois university, Springfield, IL, USA; Department of Neuropsychiatry, Minia University, Egypt
| | - Suban Amatya
- Department of Medicine, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Kriti Shrestha
- Department of Medicine, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Kanika Sharma
- Division of Multiple Sclerosis and Neuroimmunology Department of Neurology, McGovern Medical School (UT Health), University of Texas Health Science Center at Houston, Houston, TX,USA
| | - Yusuf Kagzi
- Mahatma Gandhi Memorial Medical College, Indore, India
| | - Erum Khan
- Department of Neurology, University of Alabama at Birmingham, Al, USA
| | - Rajesh Gupta
- Division of Multiple Sclerosis and Neuroimmunology Department of Neurology, McGovern Medical School (UT Health), University of Texas Health Science Center at Houston, Houston, TX,USA
| | - Amanda L Piquet
- Neuroimmunology, Neuroinfectious Disease and Neurohospitalist Sections, University of Colorado School of Medicine, CO, USA
| | - Shruti Jaiswal
- Department of Neuro-oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Sijin Wen
- West Virginia Clinical Transitional Science, Morgantown, WV, USA
| | - Michaela Tapia
- West Virginia Clinical Transitional Science, Morgantown, WV, USA
| | - Rohan Samant
- Department of Neuroradiology, McGovern Medical School (UT Health), University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sri Raghav Sista
- Division of Multiple Sclerosis and Neuroimmunology Department of Neurology, McGovern Medical School (UT Health), University of Texas Health Science Center at Houston, Houston, TX,USA
| | - Shitiz Sriwastava
- Division of Multiple Sclerosis and Neuroimmunology Department of Neurology, McGovern Medical School (UT Health), University of Texas Health Science Center at Houston, Houston, TX,USA.
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Gu J, Zhang J, Liu Q, Xu S. Neurological risks of COVID-19 in women: the complex immunology underpinning sex differences. Front Immunol 2023; 14:1281310. [PMID: 38035090 PMCID: PMC10685449 DOI: 10.3389/fimmu.2023.1281310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
The COVID-19 pandemic has uncovered many mysteries about SARS-CoV-2, including its potential to trigger abnormal autoimmune responses. Emerging evidence suggests women may face higher risks from COVID-induced autoimmunity manifesting as persistent neurological symptoms. Elucidating the mechanisms underlying this female susceptibility is now imperative. We synthesize key insights from existing studies on how COVID-19 infection can lead to immune tolerance loss, enabling autoreactive antibodies and lymphocyte production. These antibodies and lymphocytes infiltrate the central nervous system. Female sex hormones like estrogen and X-chromosome mediated effects likely contribute to dysregulated humoral immunity and cytokine profiles among women, increasing their predisposition. COVID-19 may also disrupt the delicate immunological balance of the female microbiome. These perturbations precipitate damage to neural damage through mechanisms like demyelination, neuroinflammation, and neurodegeneration - consistent with the observed neurological sequelae in women. An intentional focus on elucidating sex differences in COVID-19 pathogenesis is now needed to inform prognosis assessments and tailored interventions for female patients. From clinical monitoring to evaluating emerging immunomodulatory therapies, a nuanced women-centered approach considering the hormonal status and immunobiology will be vital to ensure equitable outcomes. Overall, deeper insights into the apparent female specificity of COVID-induced autoimmunity will accelerate the development of solutions mitigating associated neurological harm.
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Affiliation(s)
- Jienan Gu
- Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiale Zhang
- Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qianhui Liu
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shijie Xu
- Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
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Hundsberger T, Schreiner B, Roth P. Immune checkpoint inhibitors induced side effects of the peripheral nervous system. Curr Opin Neurol 2023; 36:427-431. [PMID: 37639489 DOI: 10.1097/wco.0000000000001188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE OF REVIEW This review highlights recent knowledge on the diagnosis and treatment of immune checkpoint inhibitor-induced neurological side effects (irNAE) focussing on the neuromuscular system. RECENT FINDINGS irNAEs mainly resemble sporadic neuromuscular autoimmune diseases and paraneoplastic neurological syndromes. However, neurological symptoms may be unspecific (muscle weakness, fatigue) in the oncological setting and carry the risk of misdiagnosis and delayed therapeutic intervention. The role of disease-specific neuromuscular autoantibodies in the diagnosis is controversial as preexisting autoantibodies may otherwise be present before immune checkpoint inhibitor (ICI) treatment without clinical symptoms and may not develop in case of irNAE manifestation. A new necrotising form of myositis (irMyositis) has been described presenting with facial weakness and ptosis mimicking myasthenia gravis. It comes along with a high rate of severe myocarditis accounting for a triad overlap syndrome (myasthenia/myositis/myocarditis). The role of modern biologicals in the treatment of irNAEs has to be determined. SUMMARY irNAEs are rare but carry the risk of permanent morbidity and mortality. Early suspicion and diagnosis are key to prevent neurological sequelae. Beyond interruption of ICI administration, treatment corresponds to sporadic autoimmune diseases. The myasthenia/myositis/myocarditis overlap syndrome deserves special attention as it carries the highest risk of mortality. The role of neurotoxic pretreatment regimens, preexisting subclinical neurological autoimmune diseases and the risk of ICI-re-challenge after irNAEs has to be further investigated.
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Affiliation(s)
- Thomas Hundsberger
- Department of Neurology
- Department of Medical Oncology and Haematology, Cantonal Hospital, St. Gallen
| | - Bettina Schreiner
- Department of Neurology, University of Zurich, University Hospital of Zurich, Switzerland
| | - Patrick Roth
- Department of Neurology, University of Zurich, University Hospital of Zurich, Switzerland
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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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29
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João Soares R, Miranda M, Monteiro N, Ennis G, Silva Marques J. A Case of Febrile Polyphagia With an Underlying Paraneoplastic Limbic Encephalitis. Cureus 2023; 15:e42947. [PMID: 37667691 PMCID: PMC10475271 DOI: 10.7759/cureus.42947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 09/06/2023] Open
Abstract
A 57-year-old female with a history of malignant mixed Müllerian tumors of the uterus and ovaries developed a fever of unknown origin and neuropsychiatric symptoms. Her EEG showed slow activity in the left temporal region, and brain magnetic resonance imaging revealed limbic encephalitis, leading to the diagnosis of classic paraneoplastic limbic encephalitis (PLE). During our investigation into the underlying cause of the patient's condition, we conducted a PET-CT scan, which revealed the presence of several hypermetabolic lymph nodes. One of these lymph nodes underwent a biopsy, and the results confirmed the presence of metastatic cells, indicating the likelihood of carcinoma, most probably adenocarcinoma of the gynecological tract. PLE should be considered as one of the differential diagnoses in patients with a history of cancer and acute-to-subacute neuronal and psychiatric dysfunction.
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Affiliation(s)
- Rita João Soares
- Department of Internal Medicine, Centro Hospitalar Tondela-Viseu, Viseu, PRT
| | - Mafalda Miranda
- Department of Internal Medicine, Casa de Saúde São Mateus, Viseu, PRT
| | - Nuno Monteiro
- Department of Internal Medicine, Centro Hospitalar Tondela-Viseu, Viseu, PRT
| | - Giovana Ennis
- Department of Internal Medicine, Centro Hospitalar Tondela-Viseu, Viseu, PRT
| | - Joana Silva Marques
- Department of Internal Medicine, Centro Hospitalar Tondela-Viseu, Viseu, PRT
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30
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Vaišvilas M, Ciano-Petersen NL, Macarena Villagrán-García MD, Muñiz-Castrillo S, Vogrig A, Honnorat J. Paraneoplastic encephalitis: clinically based approach on diagnosis and management. Postgrad Med J 2023; 99:669-678. [PMID: 37389581 DOI: 10.1136/postgradmedj-2022-141766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/25/2022] [Indexed: 11/04/2022]
Abstract
Paraneoplastic neurological syndromes (PNSs) comprise a subset of immune-mediated nervous system diseases triggered by an underlying malignancy. Each syndrome usually shows a distinct clinical presentation and outcome according to the associated neural antibodies. PNSs generally have a subacute onset with rapid progression and severe neurological disability. However, some patients may have hyperacute onset or even show chronic progression mimicking neurodegenerative diseases. Updated diagnostic criteria for PNS have been recently established in order to increase diagnostic specificity and to encourage standardisation of research initiatives related to PNS. Treatment for PNS includes oncological therapy and immunomodulation to halt neurological deterioration although current treatment options are seldom effective in reversing disability. Nevertheless, growing knowledge and better understanding of PNS pathogenesis promise better recognition, earlier diagnosis and novel treatment strategies. Considering that PNSs provide a model of effective anticancer immunity, the impact of these studies will extend far beyond the field of neurology.
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Affiliation(s)
- Mantas Vaišvilas
- Department of Neuro-oncology Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- Department of Neuro-oncology, Université Claude Bernard Lyon 1 Villeurbanne, Lyon, France
| | - Nicolás Lundahl Ciano-Petersen
- Department of Neuro-oncology Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- Department of Neuro-oncology, Université Claude Bernard Lyon 1 Villeurbanne, Lyon, France
| | - M D Macarena Villagrán-García
- Department of Neuro-oncology Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- Department of Neuro-oncology, Université Claude Bernard Lyon 1 Villeurbanne, Lyon, France
| | - Sergio Muñiz-Castrillo
- Department of Neuro-oncology Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- Department of Neuro-oncology, Université Claude Bernard Lyon 1 Villeurbanne, Lyon, France
| | - Alberto Vogrig
- Department of Neuro-oncology Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- Department of Neuro-oncology, Université Claude Bernard Lyon 1 Villeurbanne, Lyon, France
| | - Jérôme Honnorat
- Department of Neuro-oncology, Université Claude Bernard Lyon 1 Villeurbanne, Lyon, France
- Department of Neuro-oncology, Hospices Civils de Lyon, Bron, France
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31
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Alsalem AN, Scarffe LA, Briemberg HR, Aaroe AE, Harrison RA. Neurologic Complications of Cancer Immunotherapy. Curr Oncol 2023; 30:5876-5897. [PMID: 37366923 DOI: 10.3390/curroncol30060440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/07/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023] Open
Abstract
Immunotherapy has revolutionized cancer treatment over the past decade. As it is increasingly introduced into routine clinical practice, immune-related complications have become more frequent. Accurate diagnosis and treatment are essential, with the goal of reduced patient morbidity. This review aims to discuss the various clinical manifestations, diagnosis, treatments, and prognosis of neurologic complications associated with the use of immune checkpoint inhibitors, adoptive T-cell therapies, and T-cell redirecting therapies. We also outline a suggested clinical approach related to the clinical use of these agents.
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Affiliation(s)
- Aseel N Alsalem
- Division of Neurology, University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Leslie A Scarffe
- Division of Neurology, University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Hannah R Briemberg
- Division of Neurology, University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Ashley E Aaroe
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Rebecca A Harrison
- Division of Neurology, University of British Columbia, Vancouver, BC V6T 2B5, Canada
- Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, BC V5Z 4E6, Canada
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32
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Farina A, Birzu C, Elsensohn MH, Picca A, Muñiz-Castrillo S, Vogrig A, Villagrán-García M, Ciano-Petersen NL, Massacesi L, Hervier B, Guégan S, Kramkimel N, Vano Y, Salem JE, Allenbach Y, Maisonobe T, Assaad S, Maureille A, Devic P, Weiss N, Pegat A, Maucort-Boulch D, Ricard D, Honnorat J, Psimaras D, Joubert B. Neurological outcomes in immune checkpoint inhibitor-related neurotoxicity. Brain Commun 2023; 5:fcad169. [PMID: 37389303 PMCID: PMC10306160 DOI: 10.1093/braincomms/fcad169] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 04/03/2023] [Accepted: 05/25/2023] [Indexed: 07/01/2023] Open
Abstract
While the spectrum of neurological immune checkpoint inhibitor-related adverse events is expanding, patients' outcomes are not well documented. This study aimed to assess outcomes of neurological immune-related adverse events and to identify prognostic factors. All patients experiencing grade ≥2 neurological immune-related adverse events identified at two clinical networks (French Reference Center for Paraneoplastic Neurological Syndromes, Lyon; and OncoNeuroTox, Paris) over five years were included. Modified Rankin scores were assessed at onset, 6, 12, 18 months, and last visit. A multi-state Markov model was used to estimate the transition rates between minor disability (mRS <3), severe disability (mRS 3-5), and death (mRS 6), over the study period. The state-to-state transition rates were estimated using maximum likelihood and variables were introduced into the different transitions to study their effects. A total of 147 patients were included out of 205 patients with a suspicion of neurological immune-related adverse events. The median age was 65 years (range 20-87) and 87/147 patients (59.2%) were male. Neurological immune-related adverse events involved the peripheral nervous system in 87/147 patients (59.2%), the central nervous system in 51/147 (34.7%), and both systems in 9/147 (6.1%). Paraneoplastic-like syndromes were observed in 30/147 patients (20.4%). Cancers included lung cancers (36.1%), melanoma (30.6%), urological cancers (15.6%), and others (17.8%). Patients were treated with programmed cell death protein (ligan) 1 (PD(L)1) inhibitors (70.1%), CTLA4 inhibitors (3.4%) or both (25.9%). Severe disability was reported in 108/144 patients (75.0%) at onset and in 33/146 patients (22.6%) at last visit (median follow-up duration: 12 months, range 0.5-50); 48/147 (32.7%) patients died, from cancer progression (17/48, 35.4%), neurological toxicity (15/48, 31.2%), other causes (10/48, 20.8%) or unknown causes (6/48, 12.5%). The rate of transition from severe to minor disability independently increased with melanoma [compared to lung cancer, hazard ratio = 3.26, 95%CI (1.27; 8.41)] and myositis/neuromuscular junction disorders [hazard ratio = 8.26, 95%CI (2.90; 23.58)], and decreased with older age [hazard ratio = 0.68, 95%CI (0.47; 0.99)] and paraneoplastic-like syndromes [hazard ratio = 0.29, 95%CI (0.09; 0.98)]. In patients with neurological immune-related adverse events, myositis/neuromuscular junction disorders and melanoma increase the transition rate from severe to minor disability, while older age and paraneoplastic-like syndromes result in poorer neurological outcomes; future studies are needed to optimize the management of such patients.
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Affiliation(s)
- Antonio Farina
- Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Neurological Hospital, Bron 69677, France
- MeLiS - UCBL-CNRS UMR 5284—INSERM U1314, Université Claude Bernard Lyon 1, Lyon 69008, France
- Department of Neuroscience, Psychology, Pharmacology and Child Health, University of Florence, Florence 50139, Italy
| | - Cristina Birzu
- Department of Neurology 2 Mazarin, Sorbonne University, Brain Institute, INSERM UMR 1127, Groupe Hospitalier Pitié-Salpêtrière, Paris 75013, France
- OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments Groupe Hospitalier Pitié-Salpêtrière et Hôpital Percy, Paris 75561, France
| | | | | | - Sergio Muñiz-Castrillo
- Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Neurological Hospital, Bron 69677, France
- MeLiS - UCBL-CNRS UMR 5284—INSERM U1314, Université Claude Bernard Lyon 1, Lyon 69008, France
| | - Alberto Vogrig
- Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Neurological Hospital, Bron 69677, France
- MeLiS - UCBL-CNRS UMR 5284—INSERM U1314, Université Claude Bernard Lyon 1, Lyon 69008, France
| | - Macarena Villagrán-García
- Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Neurological Hospital, Bron 69677, France
- MeLiS - UCBL-CNRS UMR 5284—INSERM U1314, Université Claude Bernard Lyon 1, Lyon 69008, France
| | - Nicolás Lundahl Ciano-Petersen
- Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Neurological Hospital, Bron 69677, France
- MeLiS - UCBL-CNRS UMR 5284—INSERM U1314, Université Claude Bernard Lyon 1, Lyon 69008, France
| | - Luca Massacesi
- Department of Neuroscience, Psychology, Pharmacology and Child Health, University of Florence, Florence 50139, Italy
| | - Baptiste Hervier
- Department of Internal Medicine, AP-HP, Hôpital St Louis, Paris 75010, France
| | - Sarah Guégan
- Department of Dermatology, AP-HP, Hôpital Cochin, Paris 75014, France
- Department of Dermatology, Université de Paris Cité, Paris 75006, France
| | - Nora Kramkimel
- Department of Dermatology, AP-HP, Hôpital Cochin, Paris 75014, France
| | - Yann Vano
- Department of Medical Oncology, AP-HP, Centre Hôpital Européen Georges-Pompidou, Paris 75015, France
| | - Joe Elie Salem
- Department of Pharmacology, Sorbonne University, INSERM, UNICO-GRECO Cardio-oncology Program, CIC-1901, AP-HP, Hôpital Pitié-Salpêtrière, F-75013 Paris, France
| | - Yves Allenbach
- APHP, Department of Internal Medicine, Sorbonne University, Sorbonne University, INSERM Groupe Hospitalier Pitié-Salpêtrière, Paris 75651, France
| | - Thierry Maisonobe
- APHP, Department of Clinical Neurophysiology, Sorbonne University, Paris 75013, France
| | - Souad Assaad
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon 69008, France
| | - Aurélien Maureille
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon 69008, France
| | - Perrine Devic
- ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, 69002 Lyon, France
- Department of Neurology, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon 69495, France
| | - Nicolas Weiss
- Department of Neurology, Sorbonne University, Hôpital de la Pitié-Salpêtrière, unité de Médecine Intensive Réanimation à orientation neurologique, Paris 75013, France
- Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, INSERM UMR_S 938, Centre de recherche Saint-Antoine, Metabolic, Biliary and Fibro-Inflammatory Diseases of the Liver, Institute of Cardiometabolism and Nutrition (ICAN), Paris 75012, France
| | - Antoine Pegat
- Department of Neurological Functional Explorations, Hospices Civils de Lyon, Neurological Hospital, Bron 69500, France
| | - Delphine Maucort-Boulch
- Biostatistics—Bioinformatics Department, Public Health Unit. Hospices Civils de Lyon, Lyon 69003, France
- Laboratory of Biometry and Evolutionary Biology, University Claude Bernard Lyon 1, Villeurbanne 69622, France
- CNRS, UMR5558, Laboratory of Biometry and Evolutionary Biology, Biostatistics-Health Team, Villeurbanne 69622, France
| | - Damien Ricard
- OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments Groupe Hospitalier Pitié-Salpêtrière et Hôpital Percy, Paris 75561, France
- Neurology Department, Hôpital d’Instruction des Armées Percy, Service de Santé des Armées, Clamart 92140, France
| | - Jérôme Honnorat
- Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Neurological Hospital, Bron 69677, France
- MeLiS - UCBL-CNRS UMR 5284—INSERM U1314, Université Claude Bernard Lyon 1, Lyon 69008, France
- ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, 69002 Lyon, France
| | - Dimitri Psimaras
- Department of Neurology 2 Mazarin, Sorbonne University, Brain Institute, INSERM UMR 1127, Groupe Hospitalier Pitié-Salpêtrière, Paris 75013, France
- OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments Groupe Hospitalier Pitié-Salpêtrière et Hôpital Percy, Paris 75561, France
| | - Bastien Joubert
- Correspondence to: Bastien Joubert, MD, PhD French Reference Centre for Paraneoplastic Neurological Syndromes, Neurological Hospital 59 Boulevard Pinel, 69677 Bron Cedex, France E-mail:
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Abstract
Autoimmune diseases are a diverse group of conditions characterized by aberrant B cell and T cell reactivity to normal constituents of the host. These diseases occur widely and affect individuals of all ages, especially women. Among these diseases, the most prominent immunological manifestation is the production of autoantibodies, which provide valuable biomarkers for diagnosis, classification and disease activity. Although T cells have a key role in pathogenesis, they are technically more difficult to assay. In general, autoimmune disease results from an interplay between a genetic predisposition and environmental factors. Genetic predisposition to autoimmunity is complex and can involve multiple genes that regulate the function of immune cell populations. Less frequently, autoimmunity can result from single-gene mutations that affect key regulatory pathways. Infection seems to be a common trigger for autoimmune disease, although the microbiota can also influence pathogenesis. As shown in seminal studies, patients may express autoantibodies many years before the appearance of clinical or laboratory signs of disease - a period called pre-clinical autoimmunity. Monitoring autoantibody expression in at-risk populations may therefore enable early detection and the initiation of therapy to prevent or attenuate tissue damage. Autoimmunity may not be static, however, and remission can be achieved by some patients treated with current agents.
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Affiliation(s)
- David S Pisetsky
- Duke University Medical Center, Medical Research Service, Durham Veterans Administration Medical Center, Durham, NC, USA.
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34
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Marsili L, Marcucci S, LaPorta J, Chirra M, Espay AJ, Colosimo C. Paraneoplastic Neurological Syndromes of the Central Nervous System: Pathophysiology, Diagnosis, and Treatment. Biomedicines 2023; 11:biomedicines11051406. [PMID: 37239077 DOI: 10.3390/biomedicines11051406] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
Paraneoplastic neurological syndromes (PNS) include any symptomatic and non-metastatic neurological manifestations associated with a neoplasm. PNS associated with antibodies against intracellular antigens, known as "high-risk" antibodies, show frequent association with underlying cancer. PNS associated with antibodies against neural surface antigens, known as "intermediate- or low-risk" antibodies, are less frequently associated with cancer. In this narrative review, we will focus on PNS of the central nervous system (CNS). Clinicians should have a high index of suspicion with acute/subacute encephalopathies to achieve a prompt diagnosis and treatment. PNS of the CNS exhibit a range of overlapping "high-risk" clinical syndromes, including but not limited to latent and overt rapidly progressive cerebellar syndrome, opsoclonus-myoclonus-ataxia syndrome, paraneoplastic (and limbic) encephalitis/encephalomyelitis, and stiff-person spectrum disorders. Some of these phenotypes may also arise from recent anti-cancer treatments, namely immune-checkpoint inhibitors and CAR T-cell therapies, as a consequence of boosting of the immune system against cancer cells. Here, we highlight the clinical features of PNS of the CNS, their associated tumors and antibodies, and the diagnostic and therapeutic strategies. The potential and the advance of this review consists on a broad description on how the field of PNS of the CNS is constantly expanding with newly discovered antibodies and syndromes. Standardized diagnostic criteria and disease biomarkers are fundamental to quickly recognize PNS to allow prompt treatment initiation, thus improving the long-term outcome of these conditions.
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Affiliation(s)
- Luca Marsili
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Samuel Marcucci
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Joseph LaPorta
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Martina Chirra
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Carlo Colosimo
- Department of Neurology, Santa Maria University Hospital, 05100 Terni, Italy
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Ruggiero R, Di Napoli R, Balzano N, Ruggiero D, Riccardi C, Anatriello A, Cantone A, Sportiello L, Rossi F, Capuano A. Immune-related adverse events and immune checkpoint inhibitors: a focus on neurotoxicity and clinical management. Expert Rev Clin Pharmacol 2023; 16:423-434. [PMID: 37144360 DOI: 10.1080/17512433.2023.2211262] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Immune checkpoint inhibitors (ICIs) represent an innovative therapeutic approach of oncologic diseases. In Europe, this therapeutic class currently includes eight agents: ipilimumab, pembrolizumab, nivolumab, atezolizumab, avelumab, cemiplimab, durvalumab and dostarlimab. Despite their proved clinical benefits, they can induce immune related adverse events (irADRs), that can also involve the nervous system. AREAS COVERED Despite their rarity, neurological irADRs related to ICI-treatments can lead to serious and dangerous complications, highlighting the importance of a strict monitoring of patients. This review aims to summarize the safety profile of ICIs, focusing on their possible neurotoxicity and their management. EXPERT OPINION Considering the clinical relevance of ICIs-induced irADRs and that the underlying mechanisms are still not completely understood, the use of ICIs requires extensive safety monitoring. Before to prescribe immunotherapy, oncologists should identify possible individual risk factors that may favor the onset of irADRs. Oncologists and general practitioners should inform and educate patients about the specific toxicities of immunological checkpoint inhibitors, including nervous ones. They should be carefully monitored at least 6 months after the end of treatment. ICIs-related nervous toxicities require a multidisciplinary management, in which neurologists and clinical pharmacologists should participate.
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Affiliation(s)
- Rosanna Ruggiero
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Napoli, Italy
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Raffaella Di Napoli
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Napoli, Italy
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Nunzia Balzano
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Napoli, Italy
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Donatella Ruggiero
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Napoli, Italy
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Consiglia Riccardi
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Napoli, Italy
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Antonietta Anatriello
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Napoli, Italy
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Andrea Cantone
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Napoli, Italy
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Liberata Sportiello
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Napoli, Italy
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Francesco Rossi
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Napoli, Italy
| | - Annalisa Capuano
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Napoli, Italy
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Chen YC, Jaffer M, Zhou L, Moslehi J, Forsyth PA, Fecher LA. A Brain, A Heart, and the Courage: Balancing Benefit and Toxicity of Immunotherapy in Melanoma. Am Soc Clin Oncol Educ Book 2023; 43:e390594. [PMID: 37229626 DOI: 10.1200/edbk_390594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The overall survival of advanced melanoma has improved dramatically. Immunotherapies, specifically checkpoint inhibitors, have played a large role in this improvement. These agents have also shown benefit in the adjuvant setting, are approved for treatment of resected stage II, III, and IV melanoma, and play an evolving role in the neoadjuvant setting. Although generally well tolerated, immune-related adverse events occur and can be severe. Here we focus on some severe and potentially long term toxicities, including cardiovascular and neurologic toxicities. Our understanding of the acute and long-term toxicities of immune checkpoint inhibitors continues to evolve. Oncologists must continue to balance cancer risk and treatment-related toxicities.
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Affiliation(s)
- Yen-Chou Chen
- Section of Cardio-Oncology and Immunology, Cardiovascular Research Institute (CVRI), University of California, San Francisco (UCSF), San Francisco, CA
- Division of Cardiology and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Muhammad Jaffer
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL
| | - Lylybell Zhou
- Section of Cardio-Oncology and Immunology, Cardiovascular Research Institute (CVRI), University of California, San Francisco (UCSF), San Francisco, CA
| | - Javid Moslehi
- Section of Cardio-Oncology and Immunology, Cardiovascular Research Institute (CVRI), University of California, San Francisco (UCSF), San Francisco, CA
| | - Peter A Forsyth
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL
- Department of Oncology, Moffitt Cancer Center and University of South Florida, Tampa, FL
| | - Leslie A Fecher
- Rogel Cancer Center at the University of Michigan, Ann Arbor, MI
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Özdemir BC, Espinosa da Silva C, Arangalage D, Monney P, Guler SA, Huynh-Do U, Stirnimann G, Possamai L, Trepp R, Hoepner R, Salmen A, Gerard CL, Hruz P, Christ L, Rothschild SI. Multidisciplinary recommendations for essential baseline functional and laboratory tests to facilitate early diagnosis and management of immune-related adverse events among cancer patients. Cancer Immunol Immunother 2023:10.1007/s00262-023-03436-0. [PMID: 37017694 DOI: 10.1007/s00262-023-03436-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/22/2023] [Indexed: 04/06/2023]
Abstract
Immune checkpoint inhibitors (ICIs) have fundamentally changed the treatment landscape of various cancers. While ICI treatments result in improved survival, quality of life and are cost-effective, the majority of patients experience at least one immune-related adverse event (irAE). Many of these side effects cause little discomfort or are asymptomatic; however, irAEs can affect any organ and are potentially life-threatening. Consequently, early diagnosis and appropriate treatment of irAEs are critical for optimizing long-term outcomes and quality of life in affected patients. Some irAEs are diagnosed according to typical symptoms, others by abnormal findings from diagnostic tests. While there are various guidelines addressing the management of irAEs, recommendations for the early recognition of irAEs as well as the optimal extent and frequency of laboratory tests are mostly lacking. In clinical practice, blood sampling is usually performed before each ICI administration (i.e., every 2-3 weeks), often for several months, representing a burden for patients as well as health care systems. In this report, we propose essential laboratory and functional tests to improve the early detection and management of irAEs and in cancer patients treated with ICIs. These multidisciplinary expert recommendations regarding essential laboratory and functional tests can be used to identify possible irAEs at an early time point, initiate appropriate interventions to improve patient outcomes, and reduce the burden of blood sampling during ICI treatment.
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Affiliation(s)
- Berna C Özdemir
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Cristina Espinosa da Silva
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, USA
| | - Dimitri Arangalage
- Department of Cardiology, INSERM U1148, Bichat Hospital, University of Paris, Paris, France
| | - Pierre Monney
- Department of Cardiology, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Sabina A Guler
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Uyen Huynh-Do
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Guido Stirnimann
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lucia Possamai
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Roman Trepp
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism (UDEM), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Robert Hoepner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anke Salmen
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Camille L Gerard
- Department of Oncology, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
- The Francis Crick Institute, London, UK
| | - Petr Hruz
- Department of Gastroenterology, University Hospital Basel, Basel, Switzerland
| | - Lisa Christ
- Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sacha I Rothschild
- Department of Medical Oncology, University Hospital Basel, Basel, Switzerland
- Department Internal Medicine, Center for Oncology and Hematology, Cantonal Hospital Baden, Baden, Switzerland
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Farina A, Villagrán-García M, Honnorat J. Neurological adverse events of immune checkpoint inhibitors: An update of clinical presentations, diagnosis, and management. Rev Neurol (Paris) 2023; 179:506-515. [PMID: 36934022 DOI: 10.1016/j.neurol.2023.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/03/2023] [Accepted: 03/03/2023] [Indexed: 03/18/2023]
Abstract
The use of immune checkpoint inhibitors (ICIs) has represented a major advance in cancer treatment. By enhancing endogenous immune responses to destroy cancer cells, ICIs can cause immune-related adverse events (irAEs), with possible involvement of any organ system. IrAEs are frequent, particularly those involving the skin or the endocrine system, and usually completely reversible after temporary immunosuppression, while neurological irAEs (n-irAEs) are relatively rare, often severe, and they carry a considerable risk of mortality and long-term disability. They usually affect the peripheral nervous system, mainly manifesting as myositis, polyradiculoneuropathy, or cranial neuropathy, and, less frequently, involve the central nervous system, causing encephalitis, meningitis, or myelitis. Although somehow reminiscent of the disorders that neurologists are familiar to deal with in their daily practice, n-irAEs are characterized by distinctive features from their idiopathic counterparts; for instance, myositis may have a predominant oculo-bulbar involvement reminiscent of myasthenia gravis and frequently associates with myocarditis; peripheral neuropathy, although often resembling Guillain-Barré syndrome, usually responds to corticosteroids. Remarkably, several associations between the neurological phenotype and the type of ICIs or the type of cancer have emerged in the last few years, and the growing administration of ICIs in patients with neuroendocrine cancers has led to an increased number of reports of paraneoplastic neurological syndromes (triggered or worsened by ICIs). This review aims to update current knowledge regarding the clinical presentation of n-irAEs. We also discuss the essential parts of the diagnostic approach, and we provide general recommendations for the management of these disorders.
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Affiliation(s)
- A Farina
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; MeLiS, UCBL, CNRS UMR 5284, Inserm U1314, Université Claude-Bernard Lyon 1, Lyon, France; Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Firenze, Italy
| | - M Villagrán-García
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; MeLiS, UCBL, CNRS UMR 5284, Inserm U1314, Université Claude-Bernard Lyon 1, Lyon, France
| | - J Honnorat
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; MeLiS, UCBL, CNRS UMR 5284, Inserm U1314, Université Claude-Bernard Lyon 1, Lyon, France.
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Fleming B, Edison P, Kenny L. Cognitive impairment after cancer treatment: mechanisms, clinical characterization, and management. BMJ 2023; 380:e071726. [PMID: 36921926 DOI: 10.1136/bmj-2022-071726] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Cognitive impairment is a debilitating side effect experienced by patients with cancer treated with systemically administered anticancer therapies. With around 19.3 million new cases of cancer worldwide in 2020 and the five year survival rate growing from 50% in 1970 to 67% in 2013, an urgent need exists to understand enduring side effects with severe implications for quality of life. Whereas cognitive impairment associated with chemotherapy is recognized in patients with breast cancer, researchers have started to identify cognitive impairment associated with other treatments such as immune, endocrine, and targeted therapies only recently. The underlying mechanisms are diverse and therapy specific, so further evaluation is needed to develop effective therapeutic interventions. Drug and non-drug management strategies are emerging that target mechanistic pathways or the cognitive deficits themselves, but they need to be rigorously evaluated. Clinically, consistent use of objective diagnostic tools is necessary for accurate diagnosis and clinical characterization of cognitive impairment in patients treated with anticancer therapies. This should be supplemented with clinical guidelines that could be implemented in daily practice. This review summarizes the recent advances in the mechanisms, clinical characterization, and novel management strategies of cognitive impairment associated with treatment of non-central nervous system cancers.
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Affiliation(s)
- Ben Fleming
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Paul Edison
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
- College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Laura Kenny
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
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Laumont CM, Nelson BH. B cells in the tumor microenvironment: Multi-faceted organizers, regulators, and effectors of anti-tumor immunity. Cancer Cell 2023; 41:466-489. [PMID: 36917951 DOI: 10.1016/j.ccell.2023.02.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/11/2023] [Accepted: 02/12/2023] [Indexed: 03/14/2023]
Abstract
Our understanding of tumor-infiltrating lymphocytes (TILs) is rapidly expanding beyond T cell-centric perspectives to include B cells and plasma cells, collectively referred to as TIL-Bs. In many cancers, TIL-Bs carry strong prognostic significance and are emerging as key predictors of response to immune checkpoint inhibitors. TIL-Bs can perform multiple functions, including antigen presentation and antibody production, which allow them to focus immune responses on cognate antigen to support both T cell responses and innate mechanisms involving complement, macrophages, and natural killer cells. In the stroma of the most immunologically "hot" tumors, TIL-Bs are prominent components of tertiary lymphoid structures, which resemble lymph nodes structurally and functionally. Additionally, TIL-Bs participate in a variety of other lympho-myeloid aggregates and engage in dynamic interactions with the tumor stroma. Here, we summarize our current understanding of TIL-Bs in human cancer, highlighting the compelling therapeutic opportunities offered by their unique tumor recognition and effector mechanisms.
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Affiliation(s)
- Céline M Laumont
- Deeley Research Centre, BC Cancer, Victoria, BC V8R 6V5, Canada; Department of Medical Genetics, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Brad H Nelson
- Deeley Research Centre, BC Cancer, Victoria, BC V8R 6V5, Canada; Department of Medical Genetics, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; Department of Biochemistry and Microbiology, University of Victoria, Victoria, BC V8P 3E6, Canada.
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Evaluation and management of acute high-grade immunotherapy-related neurotoxicity. Heliyon 2023; 9:e13725. [PMID: 36851967 PMCID: PMC9958505 DOI: 10.1016/j.heliyon.2023.e13725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Immune checkpoint inhibitor monoclonal antibodies allow the host's immune system to attack tumors, which has revolutionized cancer care over the last decade. As the use of immune checkpoint inhibitors has expanded, so have autoimmune-like complications known as immune-related adverse events. These include the infrequent but increasingly more common, potentially deadly neurological immune related adverse events. When feeling acutely ill, patients will often seek care not from their oncologist but from their family physician, clinics, emergency, and urgent care sites, or other available providers. Thus, while assessing acutely ill cancer patients who are experiencing neurological symptoms, non-oncologists should be prepared to recognize, diagnose, and treat neurological immune related adverse events in addition to more familiar conditions. This narrative review is designed to update acute care clinicians on current knowledge and to present a symptom-based framework for evaluating and treating neurological immune related adverse events based on the leading immunotoxicity organizations' latest recommendations.
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Abstract
PURPOSE OF REVIEW To provide an overview and highlight recent updates in the field of paraneoplastic neurologic disorders. RECENT FINDINGS The prevalence of paraneoplastic neurologic disorders is greater than previously reported and the incidence has been rising over time, due to improved recognition in the era of antibody biomarkers. Updated diagnostic criteria that are broadly inclusive and also contain diagnostic risk for clinical presentations (high and intermediate) and diagnostic antibodies (high, intermediate, and low) have replaced the original 2004 criteria. Antibody biomarkers continue to be characterized (e.g., KLHL-11 associated with seminoma in men with brainstem encephalitis). Some paraneoplastic antibodies also provide insight into likely immunotherapy response and prognosis. The rise of immune checkpoint inhibitors as cancer therapeutics has been associated with newly observed immune-mediated adverse effects including paraneoplastic neurological disorders. The therapeutic approach to paraneoplastic neurologic disorders is centered around cancer care and trials of immune therapy. The field of paraneoplastic neurologic disorders continues to be advanced by the identification of novel antibody biomarkers which have diagnostic utility, and give insight into likely treatment responses and outcomes.
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Affiliation(s)
- Michael Gilligan
- Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
| | | | - Andrew McKeon
- Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, Rochester, MN, USA.
- Department of Neurology, College of Medicine, Mayo Clinic, 200 1st ST SW, Rochester, MN, 55905, USA.
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Martens A, Schauwvlieghe PP, Madoe A, Casteels I, Aspeslagh S. Ocular adverse events associated with immune checkpoint inhibitors, a scoping review. J Ophthalmic Inflamm Infect 2023; 13:5. [PMID: 36811715 PMCID: PMC9947214 DOI: 10.1186/s12348-022-00321-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/11/2022] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION Immune checkpoint inhibitors (ICIs) have become an important part of the treatment of multiple cancers, especially for advanced melanoma and non-small cell lung cancer. Some tumors are capable of escaping immunosurveillance by stimulating checkpoints on T-cells. ICIs prevent activation of these checkpoints and thereby stimulate the immune system and indirectly the anti-tumor response. However, the use of ICIs is associated with various adverse events. Ocular side effects are rare but may have a major impact on the quality of life of the patient. METHODS A comprehensive literature search of the medical databases Web of Science, Embase and PubMed was performed. Articles that provided a comprehensive description of a case report containing 1) cancer patient(s) treated with (a combination of) immune checkpoint inhibitors, and 2) assessed occurrence of ocular adverse events, were included. A total of 290 case reports were included. RESULTS Melanoma (n = 179; 61.7%) and lung cancer (n = 56; 19.3%) were the most frequent reported malignancies. The primary used ICIs were nivolumab (n = 123; 42.5%) and ipilimumab (n = 116; 40.0%). Uveitis was most the common adverse event (n = 134; 46.2%) and mainly related to melanoma. Neuro-ophthalmic disorders, including myasthenia gravis and cranial nerve disorders, were the second most common adverse events (n = 71; 24.5%), mainly related to lung cancer. Adverse events affecting the orbit and the cornea were reported in 33 (11.4%) and 30 cases (10.3%) respectively. Adverse events concerning the retina were reported in 26 cases (9.0%). CONCLUSION The aim of this paper is to provide an overview of all reported ocular adverse events related to the use of ICIs. The insights retrieved from this review might contribute to a better understanding of the underlying mechanisms of these ocular adverse events. Particularly, the difference between actual immune-related adverse events and paraneoplastic syndromes might be relevant. These findings might be of great value in establishing guidelines on how to manage ocular adverse events related to ICIs.
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Affiliation(s)
- A. Martens
- grid.410569.f0000 0004 0626 3338Department of Ophthalmology, University Hospitals Leuven, Louvain, Belgium
| | - P. P. Schauwvlieghe
- grid.410569.f0000 0004 0626 3338Department of Ophthalmology, University Hospitals Leuven, Louvain, Belgium
| | - A. Madoe
- grid.410569.f0000 0004 0626 3338Department of Ophthalmology, University Hospitals Leuven, Louvain, Belgium
| | - I. Casteels
- grid.410569.f0000 0004 0626 3338Department of Ophthalmology, University Hospitals Leuven, Louvain, Belgium
| | - S. Aspeslagh
- grid.411326.30000 0004 0626 3362Department of Medical Oncology, University Hospital Brussels, Brussels, Belgium
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Taylor J, Gandhi A, Gray E, Zaenker P. Checkpoint inhibitor immune-related adverse events: A focused review on autoantibodies and B cells as biomarkers, advancements and future possibilities. Front Immunol 2023; 13:991433. [PMID: 36713389 PMCID: PMC9874109 DOI: 10.3389/fimmu.2022.991433] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/07/2022] [Indexed: 01/13/2023] Open
Abstract
The use of immune checkpoint inhibitors (ICIs) has evolved rapidly with unprecedented treatment benefits being obtained for cancer patients, including improved patient survival. However, over half of the patients experience immune related adverse events (irAEs) or toxicities, which can be fatal, affect the quality of life of patients and potentially cause treatment interruption or cessation. Complications from these toxicities can also cause long term irreversible organ damage and other chronic health conditions. Toxicities can occur in various organ systems, with common observations in the skin, rheumatologic, gastrointestinal, hepatic, endocrine system and the lungs. These are not only challenging to manage but also difficult to detect during the early stages of treatment. Currently, no biomarker exists to predict which patients are likely to develop toxicities from ICI therapy and efforts to identify robust biomarkers are ongoing. B cells and antibodies against autologous antigens (autoantibodies) have shown promise and are emerging as markers to predict the development of irAEs in cancer patients. In this review, we discuss the interplay between ICIs and toxicities in cancer patients, insights into the underlying mechanisms of irAEs, and the involvement of the humoral immune response, particularly by B cells and autoantibodies in irAE development. We also provide an appraisal of the progress, key empirical results and advances in B cell and autoantibody research as biomarkers for predicting irAEs. We conclude the review by outlining the challenges and steps required for their potential clinical application in the future.
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Affiliation(s)
- John Taylor
- Centre for Precision Health, Edith Cowan University, Joondalup, WA, Australia,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia,*Correspondence: John Taylor,
| | - Aesha Gandhi
- Sir Charles Gairdner Hospital, Department of Medical Oncology, Nedlands, WA, Australia
| | - Elin Gray
- Centre for Precision Health, Edith Cowan University, Joondalup, WA, Australia,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Pauline Zaenker
- Centre for Precision Health, Edith Cowan University, Joondalup, WA, Australia,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
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Berz AM, Boughdad S, Vietti-Violi N, Digklia A, Dromain C, Dunet V, Duran R. Imaging assessment of toxicity related to immune checkpoint inhibitors. Front Immunol 2023; 14:1133207. [PMID: 36911692 PMCID: PMC9995973 DOI: 10.3389/fimmu.2023.1133207] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/10/2023] [Indexed: 02/25/2023] Open
Abstract
In recent years, a wide range of cancer immunotherapies have been developed and have become increasingly important in cancer treatment across multiple oncologic diseases. In particular, immune checkpoint inhibitors (ICIs) offer promising options to improve patient outcomes. However, a major limitation of these treatments consists in the development of immune-related adverse events (irAEs) occurring in potentially any organ system and affecting up to 76% of the patients. The most frequent toxicities involve the skin, gastrointestinal tract, and endocrine system. Although mostly manageable, potentially life-threatening events, particularly due to neuro-, cardiac, and pulmonary toxicity, occur in up to 30% and 55% of the patients treated with ICI-monotherapy or -combination therapy, respectively. Imaging, in particular computed tomography (CT), magnetic resonance imaging (MRI), and 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography (18F-FDG-PET/CT), plays an important role in the detection and characterization of these irAEs. In some patients, irAEs can even be detected on imaging before the onset of clinical symptoms. In this context, it is particularly important to distinguish irAEs from true disease progression and specific immunotherapy related response patterns, such as pseudoprogression. In addition, there are irAEs which might be easily confused with other pathologies such as infection or metastasis. However, many imaging findings, such as in immune-related pneumonitis, are nonspecific. Thus, accurate diagnosis may be delayed underling the importance for adequate imaging features characterization in the appropriate clinical setting in order to provide timely and efficient patient management. 18F-FDG-PET/CT and radiomics have demonstrated to reliably detect these toxicities and potentially have predictive value for identifying patients at risk of developing irAEs. The purpose of this article is to provide a review of the main immunotherapy-related toxicities and discuss their characteristics on imaging.
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Affiliation(s)
- Antonia M Berz
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Sarah Boughdad
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Naïk Vietti-Violi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Antonia Digklia
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Clarisse Dromain
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Vincent Dunet
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Rafael Duran
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Alberti P, Salvalaggio A, Argyriou AA, Bruna J, Visentin A, Cavaletti G, Briani C. Neurological Complications of Conventional and Novel Anticancer Treatments. Cancers (Basel) 2022; 14:cancers14246088. [PMID: 36551575 PMCID: PMC9776739 DOI: 10.3390/cancers14246088] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Various neurological complications, affecting both the central and peripheral nervous system, can frequently be experienced by cancer survivors after exposure to conventional chemotherapy, but also to modern immunotherapy. In this review, we provide an overview of the most well-known adverse events related to chemotherapy, with a focus on chemotherapy induced peripheral neurotoxicity, but we also address some emerging novel clinical entities related to cancer treatment, including chemotherapy-related cognitive impairment and immune-mediated adverse events. Unfortunately, efficacious curative or preventive treatment for all these neurological complications is still lacking. We provide a description of the possible mechanisms involved to drive future drug discovery in this field, both for symptomatic treatment and neuroprotection.
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Affiliation(s)
- Paola Alberti
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- NeuroMI (Milan Center for Neuroscience), 20126 Milan, Italy
| | | | - Andreas A. Argyriou
- Neurology Department, Agios Andreas State General Hospital of Patras, 26335 Patras, Greece
| | - Jordi Bruna
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO Hospitalet, Bellvitge Institute for Biomedical Research (IDIBELL), 08908 Barcelona, Spain
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35131 Padova, Italy
| | - Guido Cavaletti
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Chiara Briani
- Neurology Unit, Department of Neurosciences, University of Padova, 35131 Padova, Italy
- Correspondence:
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Cuzzubbo S, Carpentier AF. Neurological adverse events of immune checkpoint blockade: from pathophysiology to treatment. Curr Opin Neurol 2022; 35:814-822. [PMID: 36226705 DOI: 10.1097/wco.0000000000001113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW We review the recent advances in neurological toxicities of immune checkpoint inhibitors, with a focus on underlying pathophysiologic mechanisms and the implications on their therapeutical management. RECENT FINDINGS A growing number of cancer patients benefit from immune checkpoint agents and oncologists are increasingly confronted with these novel autoimmune syndromes. During the last years, further progresses have occurred in this field, notably in the identification of specific clinical patterns, such as the association of myasthenic syndrome with myositis and myocarditis, and polyradiculoneuropathies accompanied by cerebrospinal fluid lymphocytic pleocytosis. In addition, recent immune-histological studies improved the understanding of the pathophysiologic mechanisms behind immune-related neurotoxicities. SUMMARY Neurological toxicity is rare compared with other organs and systems, but its potential morbidity and mortality requires a prompt management. If there is a consensus for steroids as a first-line treatment, no exhaustive clinical data exist for other treatments. Recent advances in the knowledge of pathophysiological mechanisms (behind these toxicities) should be taken into account for the management of these patients. Drugs targeting T-cell mediated inflammation should be preferred in patients who are refractory to steroids, whereas therapies targeting humoral mechanisms should be considered in specific cases associated with autoantibodies such as immune-related myasthenic syndrome.
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Affiliation(s)
- Stefania Cuzzubbo
- Service de Neurologie, AP-HP, Hôpital Saint-Louis, Paris, France
- Université Paris Cité, Paris, France
| | - Antoine F Carpentier
- Service de Neurologie, AP-HP, Hôpital Saint-Louis, Paris, France
- Université Paris Cité, Paris, France
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AQP4-IgG-positive neuromyelitis optica spectrum disorder and temporally detected neoplasms: case report and systematic review. Mult Scler Relat Disord 2022; 68:104212. [PMID: 36242805 DOI: 10.1016/j.msard.2022.104212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 09/24/2022] [Accepted: 10/02/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND An increasing number of reports on associations between neoplasms and neuromyelitis optica spectrum disorder (NMOSD) have been published over the past decade. However, types of neoplasms and temporal relationships have not been widely studied. OBJECTIVE To report cases and determine the associations between neoplasms and NMOSD. METHOD A retrospective chart review of possible paraneoplastic NMOSD patients at a university hospital was performed. Articles related to "neoplasm" and "NMOSD" were systematically searched and reviewed. We included aquaporin-4 (AQP4)-IgG-seropositive NMOSD patients whose onset of NMOSD and cancer diagnosis or recurrence were within 24 months of one another. Temporal relationship, types of neoplasms involved, treatments, and outcomes of both NMOSD and neoplasms were determined. The subgroup analysis was based on the AQP4 expression of neoplasm histology. RESULTS We identified 3 cases (1.3%) from a cohort of 224 AQP4-IgG-seropositive NMOSD at our hospital and retrieved 68 cases from a systematic review, totaling 71 cases of possible paraneoplastic NMOSD. The median age at onset of NMOSD was 55 (IQR 41-64) years. Eighty percent were female. The most frequently identified types of neoplasms were lung and breast, accounting for 21.1% and 18.3%, respectively. The other tumor types were ovarian tumors and hematologic malignancy, both at 12.7%. The most commonly identified tissue histology was adenocarcinoma (52.1%). We also reported the first case of melanoma in an NMOSD patient. Twenty-eight patients (39.4%) were diagnosed with cancer before the onset of NMOSD with a median duration of 9.5 (range 1-24) months. Of those, eight patients had NMOSD after surgical removal of neoplasms, and one patient had NMOSD after radiotherapy of prostate adenocarcinoma. Twenty-three patients (32.4%) had NMOSD before cancer diagnosis by a median of 3 (range 1-24) months, and the rest were diagnosed concurrently during the same admission. Three cases were diagnosed with NMOSD around the time of tumor recurrence. Tumor tissue expressed AQP4 in 82.4%. CONCLUSION A small proportion of AQP4-IgG-positive NMOSD is associated with malignancy. In newly diagnosed NMOSD patients without symptoms of neoplasms, screening for age- and risk-appropriate cancer should be recommended, similar to the general population. The occurrence of NMOSD in cancer patients might suggest tumor recurrence.
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Farina A, Villagrán-García M, Ciano-Petersen NL, Vogrig A, Muñiz-Castrillo S, Taillandier L, Michaud M, Lefilliatre M, Wang A, Lepine Z, Picard G, Wucher V, Dhairi M, Fabien N, Goncalves D, Rogemond V, Joubert B, Honnorat J. Anti-Hu Antibodies in Patients With Neurologic Side Effects of Immune Checkpoint Inhibitors. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 10:10/1/e200058. [PMID: 36446613 PMCID: PMC9709718 DOI: 10.1212/nxi.0000000000200058] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/19/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND AND OBJECTIVES To clinically characterize post-immune checkpoint inhibitor (ICI) Hu antibody (Ab) neurologic disorders, we analyzed Hu-Ab-positive patients with neurologic immune-related adverse events (n-irAEs) and compared them with patients with other n-irAEs, ICI-naive patients with Hu-Ab paraneoplastic neurologic syndromes (PNSs) identified in the same study center, and those with Hu-Ab n-irAEs reported elsewhere. METHODS Patients whose samples were sent to the French reference center for a suspicion of n-irAE (2015-2021) were identified; those with a final diagnosis of n-irAE and Hu-Ab were included. Control groups included patients with a final diagnosis of n-irAE occurring during the same period as the patients included (2018-2021) but without Hu-Ab, and ICI-naive patients with Hu-Ab PNS diagnosed during the same period; a systematic review was performed to identify previous reports. RESULTS Eleven patients with Hu-Ab and n-irAEs were included (median age, 66 years, range 44-76 years; 73% men). Ten patients had small cell lung cancer, and 1 had lung adenocarcinoma. The median follow-up from onset was 3 months (range 0.5-18 months). Compared with those with other n-irAEs (n = 63), Hu-Ab-positive patients had more frequently co-occurring involvement of both central and peripheral nervous systems (36% vs 8%, p = 0.02) and limbic (54% vs 14%, p < 0.01), brainstem (27% vs 5%, p = 0.02), and dorsal root ganglia (45% vs 5%, p < 0.01) involvement. The proportion of patients with severe disability (modified Rankin Scale score >3) at diagnosis was higher among Hu-Ab n-irAEs (91% vs 52%, p = 0.02). Patients with Hu-Ab had also poorer outcome (100% vs 28%, p < 0.01) and higher mortality (91% vs 46%, p < 0.01). There was no significant difference in terms of clinical features between Hu-Ab n-irAEs and ICI-naive Hu-Ab PNS (n = 92), but there was a poorer outcome (56/78, 71%, p < 0.01) and higher mortality (26%, p < 0.01) among the former. No significant difference was found between the patients reported herein and those in the literature. DISCUSSION The presence of Hu-Ab identifies a subgroup of n-irAEs that consistently reproduce the phenotypes of Hu-Ab-related PNS, supporting the hypothesis of ICI triggering or unmasking PNS. As these patients show high disability and mortality, further studies are required to investigate the underlying immunopathogenic mechanisms and to improve the outcome of Hu-Ab n-irAEs.
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Affiliation(s)
- Antonio Farina
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Macarena Villagrán-García
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Nicolás Lundahl Ciano-Petersen
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Alberto Vogrig
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Sergio Muñiz-Castrillo
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Luc Taillandier
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Maud Michaud
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Mathilde Lefilliatre
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Adrien Wang
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Zoe Lepine
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Géraldine Picard
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Valentin Wucher
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Maroua Dhairi
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Nicole Fabien
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - David Goncalves
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Véronique Rogemond
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Bastien Joubert
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Jèrôme Honnorat
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France.
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Rößling R, Prüß H. Autoimmun vermittelte Enzephalitis. FORTSCHRITTE DER NEUROLOGIE · PSYCHIATRIE 2022; 90:529-542. [DOI: 10.1055/a-1803-8805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Autoimmunenzephalitiden bilden eine heterogene Gruppe neurologischer und
psychiatrischer Erkrankungen. Es werden Antikörper-vermittelte
Enzephalitiden von den häufig paraneoplastisch auftretenden
Antikörper-assoziierten Enzephalitiden unterschieden. Während
die Antikörper im ersten Fall direkt krankheitsverursachend sind, dienen
sie im zweiten Fall als diagnostischer Biomarker mit hoher Aussagekraft
für einen zugrunde liegenden Tumor.
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