Early-onset meningitis associated with atezolizumab treatment for non-small cell lung cancer: case report and literature
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Early-onset meningitis associated with atezolizumab treatment for non-small cell lung cancer: case report and literature review Koichi Ogawa 1 & Hiroyasu Kaneda 2 & Tamaki Kawamoto 1 & Yoko Tani 2 & Motohiro Izumi 1 & Yoshiya Matsumoto 1 & Kenji Sawa 1 & Tomohiro Suzumura 2 & Tetsuya Watanabe 1 & Shigeki Mitsuoka 2 & Kazuhisa Asai 1 & Tomoya Kawaguchi 1,2 Received: 13 March 2020 / Accepted: 7 May 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Summary Immune checkpoint inhibitors (ICIs) have improved the overall survival of many patients with advanced cancers. However, unlike cytotoxic and targeted drugs, ICIs may cause various immune-related adverse events (irAEs). Among these irAEs, autoimmune meningitis is very rare. Here, we report a case of early-onset, atezolizumab-induced meningitis after administration of one dose of atezolizumab. A 56-year-old man with lung adenocarcinoma had received seventh-line treatment with atezolizumab when he experienced dysarthria. Blood examinations, including the measurement of electrolytes, glucose, and organ functions, were unremarkable, but enhanced head magnetic resonance imaging T1-weighted images showed meningeal enhancement. Although cerebral spinal fluid (CSF) examinations revealed elevated lymphocyte and protein levels, no cancer cells were detected in the CSF. CSF cultures and serological tests, including polymerase chain reaction for herpes simplex virus, were negative. The patient was therefore diagnosed with atezolizumab-triggered autoimmune meningitis. With steroid treatment, the patient’s clinical and neurological state improved immediately and he recovered to baseline conditions. Prompt diagnosis and therapeutic intervention are essential for the effective treatment of autoimmune meningitis. Keywords Atezolizumab . Immune-related adverse event . Non-small cell lung cancer . Meningitis . Neurotoxicity
Introduction Immunotherapy has significantly improved the overall survival (OS) in patients with advanced cancers across a wide range of tumor types. Atezolizumab is a standard treatment in patients with previously treated advanced non-small-cell lung cancer (NSCLC) based on the improved OS results compared with docetaxel showed in the phase III trial [1]. Immune checkpoint inhibitors (ICIs) are known to cause unique immune-related adverse effects (irAEs). Common irAEs associated with the skin, gastro-intestinal (GI) tract, endocrine system, and liver are well documented with ICIs.
* Hiroyasu Kaneda [email protected] 1
Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, 545-8585 Osaka, Japan
2
Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, 545-8585 Osaka, Japan
However, neurological irAEs as well as cardiac and renal toxicities that occur in < 1% of patients are rare [2]. Although autoimmune meningitis is very rare and usually reversible, it may become irreversible and fatal
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