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Bastiaansen AEM, de Jongste AHC, de Bruijn MAAM, Crijnen YS, Schreurs MWJ, Verbeek MM, Dumoulin DW, Taal W, Titulaer MJ, Sillevis Smitt PAE. Phase II trial of natalizumab for the treatment of anti-Hu associated paraneoplastic neurological syndromes. Neurooncol Adv 2021; 3:vdab145. [PMID: 34693289 PMCID: PMC8528262 DOI: 10.1093/noajnl/vdab145] [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] [Indexed: 11/16/2022] Open
Abstract
Background Paraneoplastic neurological syndromes with anti-Hu antibodies (Hu-PNS) have a very poor prognosis: more than half of the patients become bedridden and median survival is less than 12 months. Several lines of evidence suggest a pathogenic T cell-mediated immune response. Therefore, we conducted a prospective open-label phase II trial with natalizumab. Methods Twenty Hu-PNS patients with progressive disease were treated with a maximum of three monthly natalizumab cycles (300 mg). The primary outcome measure was functional improvement, this was defined as at least one point decrease in modified Rankin Scale (mRS) score at the last treatment visit. In addition, treatment response was assessed wherein a mRS score ≤3 after treatment was defined as treatment responsive. Results The median age at onset was 67.8 years (SD 8.4) with a female predominance (n = 17, 85%). The median time from symptom onset to Hu-PNS diagnosis was 5 months (IQR 2–11). Most patients had subacute sensory neuronopathy (n = 15, 75%), with a median mRS of 4 at baseline. Thirteen patients had a tumor, all small cell lung cancer. After natalizumab treatment, two patients (10%) showed functional improvement. Of the remaining patients, 60% had a stable functional outcome, while 30% showed further deterioration. Treatment response was classified as positive in nine patients (45%). Conclusions Natalizumab may ameliorate the disease course in Hu-PNS, but no superior effects above other reported immunosuppressive and immunomodulatory were observed. More effective treatment modalities are highly needed. Trial registration https://www.clinicaltrialsregister.eu/ctr-search/trial/2014-000675-13/NL
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Affiliation(s)
- Anna E M Bastiaansen
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Adriaan H C de Jongste
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Yvette S Crijnen
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Marco W J Schreurs
- Department of Immunology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Marcel M Verbeek
- Department of Neurology and Laboratory Medicine, Donders Institute for Brain Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Daphne W Dumoulin
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Walter Taal
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Maarten J Titulaer
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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de Jongste AH, van Gelder T, Bromberg JE, de Graaf MT, Gratama JW, Schreurs MW, Hooijkaas H, Sillevis Smitt PA. A prospective open-label study of sirolimus for the treatment of anti-Hu associated paraneoplastic neurological syndromes. Neuro Oncol 2014; 17:145-50. [PMID: 24994790 DOI: 10.1093/neuonc/nou126] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Several lines of evidence suggest a T cell-mediated immune response in paraneoplastic neurological syndromes with anti-Hu antibodies (Hu-PNS). In order to investigate whether suppression of T cell-mediated immune responses in Hu-PNS patients improved their neurological outcome, we performed a prospective open-label, single-arm study on sirolimus. METHODS Seventeen progressive Hu-PNS patients were treated with sirolimus with an intended treatment duration of 8 weeks. Primary outcome measures were (i) functional improvement, defined as a decrease of one or more points on the modified Rankin Scale (mRS), and (ii) improvement of neurological impairment, defined as an increase of one or more points on the Edinburgh Functional Impairment Tests (EFIT). RESULTS One patient showed improvement on both clinical scales (mRS and EFIT). This patient presented with limbic encephalitis and improved dramatically from an mRS score of 3 to mRS 1. Another patient, with subacute sensory neuronopathy, remained stable at mRS 2 and improved one point on the EFIT scale. The other patients showed no improvement on the primary outcome measures. Median survival was 21 months. CONCLUSION We conclude that treatment of Hu-PNS patients with sirolimus may improve or stabilize their functional disabilities and neurological impairments. However, the effects of this T cell-targeted therapy were not better than reported in trials on other immunotherapies for Hu-PNS. Trial Registration https://www.clinicaltrialsregister.eu/ctr-search/trial/2008-000793-20/NL.
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Affiliation(s)
- Adriaan H de Jongste
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands (A.H.d.J., J.E.B., M.T.d.G., P.A.S.S.); Department of Medical Oncology, Erasmus University Medical Center, Rotterdam, Netherlands (A.H.d.J., J.W.G); Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, Netherlands (T.v.G.); Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands (T.v.G.); Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands (M.W.S., H.H.)
| | - Teun van Gelder
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands (A.H.d.J., J.E.B., M.T.d.G., P.A.S.S.); Department of Medical Oncology, Erasmus University Medical Center, Rotterdam, Netherlands (A.H.d.J., J.W.G); Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, Netherlands (T.v.G.); Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands (T.v.G.); Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands (M.W.S., H.H.)
| | - Jacoline E Bromberg
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands (A.H.d.J., J.E.B., M.T.d.G., P.A.S.S.); Department of Medical Oncology, Erasmus University Medical Center, Rotterdam, Netherlands (A.H.d.J., J.W.G); Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, Netherlands (T.v.G.); Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands (T.v.G.); Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands (M.W.S., H.H.)
| | - Marieke T de Graaf
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands (A.H.d.J., J.E.B., M.T.d.G., P.A.S.S.); Department of Medical Oncology, Erasmus University Medical Center, Rotterdam, Netherlands (A.H.d.J., J.W.G); Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, Netherlands (T.v.G.); Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands (T.v.G.); Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands (M.W.S., H.H.)
| | - Jan W Gratama
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands (A.H.d.J., J.E.B., M.T.d.G., P.A.S.S.); Department of Medical Oncology, Erasmus University Medical Center, Rotterdam, Netherlands (A.H.d.J., J.W.G); Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, Netherlands (T.v.G.); Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands (T.v.G.); Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands (M.W.S., H.H.)
| | - Marco W Schreurs
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands (A.H.d.J., J.E.B., M.T.d.G., P.A.S.S.); Department of Medical Oncology, Erasmus University Medical Center, Rotterdam, Netherlands (A.H.d.J., J.W.G); Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, Netherlands (T.v.G.); Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands (T.v.G.); Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands (M.W.S., H.H.)
| | - Herbert Hooijkaas
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands (A.H.d.J., J.E.B., M.T.d.G., P.A.S.S.); Department of Medical Oncology, Erasmus University Medical Center, Rotterdam, Netherlands (A.H.d.J., J.W.G); Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, Netherlands (T.v.G.); Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands (T.v.G.); Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands (M.W.S., H.H.)
| | - Peter A Sillevis Smitt
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands (A.H.d.J., J.E.B., M.T.d.G., P.A.S.S.); Department of Medical Oncology, Erasmus University Medical Center, Rotterdam, Netherlands (A.H.d.J., J.W.G); Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, Netherlands (T.v.G.); Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands (T.v.G.); Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands (M.W.S., H.H.)
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