Immune Checkpoint Inhibitor-related Guillain-Barré Syndrome: A Case Series and Review of the Literature.
Aged
Antibodies, Monoclonal, Humanized
/ adverse effects
Fatal Outcome
Guillain-Barre Syndrome
/ chemically induced
Humans
Immune Checkpoint Inhibitors
/ adverse effects
Immunoglobulins, Intravenous
/ therapeutic use
Male
Melanoma
/ drug therapy
Middle Aged
Nivolumab
/ adverse effects
Prednisolone
/ therapeutic use
Prostatic Neoplasms, Castration-Resistant
/ drug therapy
Journal
Journal of immunotherapy (Hagerstown, Md. : 1997)
ISSN: 1537-4513
Titre abrégé: J Immunother
Pays: United States
ID NLM: 9706083
Informations de publication
Date de publication:
01 09 2021
01 09 2021
Historique:
received:
14
11
2020
accepted:
02
02
2021
pubmed:
25
3
2021
medline:
22
3
2022
entrez:
24
3
2021
Statut:
ppublish
Résumé
Immune checkpoint inhibitors (ICIs) have been approved for the treatment of various malignancies with promising clinical outcomes. Treatment can, however, be accompanied by serious immune-related adverse events. Neurological adverse events like Guillain-Barré syndrome (GBS) are rare but potentially life-threatening. We present 3 cases of ICI-related GBS; review cases described in current literature, and discuss treatment strategies. Three patients developed GBS after ICI treatment. The first case with pembrolizumab had a fatal outcome despite treatment with multiple regimens, including steroids and intravenous immunoglobulin (IVIg). The other 2 cases with nivolumab-induced and pembrolizumab-induced GBS, respectively, responded well to treatment with IVIg and steroids. In the current literature, a total of 31 other cases were found. Treatment for ICI-related GBS mostly consisted of concurrent IVIg and steroids (44%), which led to clinical improvement in 73%. Most patients recovered with remaining symptoms (68%), while 10 patients developed respiratory failure (29%) and 6 patients (18%) died. ICI-related GBS should be suspected in patients on ICI treatment who develop subacute progressive weakness of the limbs, sensory loss, and areflexia. On the basis of the guidelines recommendations and our review of the literature, we advise first-line therapy with concurrent IVIg 0.4 g/kg/d for 5 days and prednisolone 1-2 mg/kg/d. Discontinuation of immunotherapy after ICI-related GBS is advised.
Identifiants
pubmed: 33758147
doi: 10.1097/CJI.0000000000000364
pii: 00002371-202109000-00005
doi:
Substances chimiques
Antibodies, Monoclonal, Humanized
0
Immune Checkpoint Inhibitors
0
Immunoglobulins, Intravenous
0
Nivolumab
31YO63LBSN
Prednisolone
9PHQ9Y1OLM
pembrolizumab
DPT0O3T46P
Types de publication
Case Reports
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
276-282Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
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