Small-cell Lung Carcinoma with Gastrointestinal Pseudo-obstruction as a Paraneoplastic Neurological Syndrome Elicited by an Immune Checkpoint Inhibitor

Intern Med. 2024 Jul 15;63(14):2059-2062. doi: 10.2169/internalmedicine.2648-23. Epub 2023 Dec 4.

Abstract

Gastrointestinal pseudo-obstruction (GIPO) is a phenotype of the paraneoplastic neurological syndrome (PNS). We herein report a case of small-cell lung carcinoma (SCLC) with GIPO elicited by an immune checkpoint inhibitor (ICI). A 75-year-old man with SCLC developed intractable intestinal obstruction after receiving one course of anticancer drugs (durvalumab, etoposide, and carboplatin). The serum anti-Hu antibody (Hu-Ab) was positive, and the patient was diagnosed with GIPO. Corticosteroid treatment did not improve the GIPO, and the patient died. There are few reports of GIPO after ICI treatment in patients with lung cancer, so a further investigation will be required to elucidate the mechanism by which ICIs elicit PNS. Checking for neuronal antibodies may help identify patients with SCLC who are at risk of developing PNS due to ICI treatment.

Keywords: anti-Hu antibody; gastrointestinal pseudo-obstruction; immune checkpoint inhibitor; paraneoplastic neurological syndrome; small-cell lung carcinoma.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • ELAV Proteins / immunology
  • Fatal Outcome
  • Humans
  • Immune Checkpoint Inhibitors* / adverse effects
  • Immune Checkpoint Inhibitors* / therapeutic use
  • Intestinal Pseudo-Obstruction* / diagnosis
  • Intestinal Pseudo-Obstruction* / etiology
  • Lung Neoplasms* / complications
  • Lung Neoplasms* / drug therapy
  • Male
  • Paraneoplastic Syndromes, Nervous System* / diagnosis
  • Paraneoplastic Syndromes, Nervous System* / etiology
  • Paraneoplastic Syndromes, Nervous System* / immunology
  • Small Cell Lung Carcinoma* / complications
  • Small Cell Lung Carcinoma* / drug therapy

Substances

  • Immune Checkpoint Inhibitors
  • ELAV Proteins