Polyradiculoneuropathy induced by immune checkpoint inhibitors: a case series and review of the literature
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Polyradiculoneuropathy induced by immune checkpoint inhibitors: a case series and review of the literature Kensuke Okada1 · Morinobu Seki1 · Hiroshi Yaguchi2 · Kenichi Sakuta2 · Taiji Mukai2 · Satoshi Yamada3 · Koichi Oki3 · Jin Nakahara1 · Shigeaki Suzuki1 Received: 19 July 2020 / Revised: 29 August 2020 / Accepted: 2 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objective The purpose of the present study is to report the clinical characteristics of polyradiculoneuropathy induced by immune checkpoint inhibitors (ICIs). Methods We retrospectively reviewed lists of all inpatients with neurological immune-related adverse events (irAEs) treated at the neurology departments of three hospitals in January 2017 and December 2019. We also performed a review of the previous case reports with polyradiculoneuropathy induced by ICI therapy. Results We had 4 patients with polyradiculoneuropathy following ICI therapy. We comprehensively reviewed our 4 patients and 32 previous case reports. There were 28 men and 8 women with a mean onset age of 61 years. ICI monotherapy was performed in 27 patients, whereas the combination of ICIs was administered in 9 patients. All patients except 2 showed limb weakness, which was observed symmetrically and predominantly in the legs rather than the arms. Bulbar involvement was observed in 7 patients. The laboratory findings were demyelination in electrophysiological studies and elevated protein with lymphocytes in the cerebrospinal fluid. Disease severity was ranked on the Hughes functional scale; 17 patients were grade 4 or greater. The treatment responses to corticosteroid and intravenous methylprednisolone were favorable. Intravenous immunoglobulin was also used in combination with steroids. Seven patients died, including 4 who on mechanical ventilation. Conclusion Polyradiculoneuropathy induced by ICIs has a distinct subset of neurological irAEs and requires early recognition. Keywords Neuropathy · Chronic inflammatory demyelinating polyradiculoneuropathy · Guillain–Barré syndrome · Immune checkpoint inhibitors · Immune-related adverse events · Review of literature
Introduction As cancer treatment with immune checkpoint inhibitors (ICIs) has become more common, the safety management of immune-related adverse events (irAEs) has become more important. Although irAEs including dermatological, Kensuke Okada and Morinobu Seki contributed equally. * Shigeaki Suzuki [email protected] 1
Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku‑ku, Tokyo 160‑8582, Japan
2
Department of Neurology, Jikei University Kashiwa Hospital, 163‑1 Kashiwashita, Kashiwa‑shi, Chiba 277‑8567, Japan
3
Department of Neurology, Tokyo Saiseikai Central Hospital, 1‑4‑17 Mita, Minato‑ku, Tokyo 108‑0073, Japan
gastrointestinal, endocrine and hepatic toxicities are usually low grade and can be managed successfully with supportive care, neurological irAEs are sometimes serious and require prompt diagnosis [4
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