Worsening of anti-Hu paraneoplastic neurological syndrome related to anti-PD-1 treatment: Case report and review of literature

Pooja Raibagkar; Doreen Ho; Krishna S Gunturu; Jayashri Srinivasan

doi:10.1016/j.jneuroim.2020.577184

Worsening of anti-Hu paraneoplastic neurological syndrome related to anti-PD-1 treatment: Case report and review of literature

J Neuroimmunol. 2020 Apr 15:341:577184. doi: 10.1016/j.jneuroim.2020.577184. Epub 2020 Feb 3.

Authors

Pooja Raibagkar¹, Doreen Ho², Krishna S Gunturu³, Jayashri Srinivasan²

Affiliations

¹ Division of Neurology, Lahey Hospital & Medical Center, Burlington, MA, United States of America; Tufts University School of Medicine, Boston, MA, United States of America. Electronic address: [email protected].
² Division of Neurology, Lahey Hospital & Medical Center, Burlington, MA, United States of America; Tufts University School of Medicine, Boston, MA, United States of America.
³ Tufts University School of Medicine, Boston, MA, United States of America; Division of Oncology, Lahey Hospital & Medical Center, Burlington, MA, United States of America.

PMID: 32058173
DOI: 10.1016/j.jneuroim.2020.577184

Abstract

We present an illustrative case of a 62-year-old woman with small cell lung cancer who developed progressive worsening of pre-existing anti-Hu antibody associated sensory neuronopathy after treatment with programmed cell death-1 (PD-1) inhibitor, nivolumab. We review the literature and identify 6 reported cases to understand the clinical outcomes of patients with anti-Hu paraneoplastic neurologic syndrome (PNS) treated with anti-PD-1 treatment. The PNS clinical spectrum comprised of encephalitis, a combination of sensory neuronopathy and anti-NMDAR encephalitis, isolated sensory neuronopathy, and encephalomyelitis. Immune checkpoint inhibitor have the potential to worsen pre-existing anti-Hu PNS and may promote the development of anti-Hu PNS.

Keywords: Anti-PD-1 inhibitor; Immune checkpoint inhibitor; Neurologic immune related adverse events; Nivolumab, anti-Hu antibody; Paraneoplastic syndrome.

Publication types

Case Reports
Review

MeSH terms

Antibodies, Antinuclear / blood*
Antibodies, Antinuclear / immunology
Antibodies, Neoplasm
Antineoplastic Agents, Immunological / adverse effects*
Antineoplastic Agents, Immunological / therapeutic use
Antineoplastic Combined Chemotherapy Protocols / therapeutic use
Autoantigens / immunology*
Carboplatin / administration & dosage
Carcinoma, Small Cell / complications
Carcinoma, Small Cell / drug therapy
Carcinoma, Small Cell / immunology
Carcinoma, Small Cell / secondary
Cerebellar Neoplasms / complications
Cerebellar Neoplasms / drug therapy
Cerebellar Neoplasms / immunology
Cerebellar Neoplasms / secondary
Combined Modality Therapy
Disease Progression
ELAV Proteins / immunology*
Etoposide / administration & dosage
Female
Humans
Lung Neoplasms / complications
Lung Neoplasms / drug therapy
Lung Neoplasms / immunology
Lung Neoplasms / radiotherapy
Middle Aged
Nivolumab / adverse effects*
Nivolumab / therapeutic use
Paraneoplastic Syndromes, Nervous System / chemically induced
Paraneoplastic Syndromes, Nervous System / etiology*
Paraneoplastic Syndromes, Nervous System / immunology
Programmed Cell Death 1 Receptor / antagonists & inhibitors*
Radiotherapy, Adjuvant
Treatment Outcome

Substances

ANNA1 antibody
Antibodies, Antinuclear
Antibodies, Neoplasm
Antineoplastic Agents, Immunological
Autoantigens
ELAV Proteins
PDCD1 protein, human
Programmed Cell Death 1 Receptor
Nivolumab
Etoposide
Carboplatin