Renal Cell Carcinoma with Central Nervous System Demyelination Caused by Nivolumab

Overview

Journal IJU Case Rep

Date 2021 Jan 11

PMID 33426497

Citations 1

Authors

Toshiki Oka

Yoshiyuki Yamamoto

Yohei Okuda

Toshihisa Asakura

Koji Hatano

Yasutomo Nakai

Masashi Nakayama

Ken-Ichi Kakimoto

Fuminobu Sugai

Kazuo Nishimura

Affiliations

Soon will be listed here.

Abstract

Introduction: Central nervous system demyelination caused by immune checkpoint inhibitors is a very rare condition.

Case Presentation: A 65-year-old man who received nivolumab for renal cell carcinoma developed abnormal behavior, such as disagreeable speech and sudden anger. Brain-enhanced magnetic resonance imaging revealed multiple lesions with partial contrast effects in the cerebral white matter. We tentatively diagnosed demyelination caused by nivolumab, and performed steroid pulse therapy twice. After that, his symptoms improved. For the next 2 years, his symptoms did not recur, nor did his cancer progress.

Conclusion: Demyelination caused by immune checkpoint inhibitors can be fatal and requires early diagnosis and treatment.

Citing Articles

Renal cell carcinoma with central nervous system demyelination caused by nivolumab.

Oka T, Yamamoto Y, Okuda Y, Asakura T, Hatano K, Nakai Y IJU Case Rep. 2021; 4(1):44-48.

PMID: 33426497 PMC: 7784733. DOI: 10.1002/iju5.12234.

References

Zafar Z, Vogler C, Hudali T, Bhattarai M . Nivolumab-Associated Acute Demyelinating Encephalitis: A Case Report and Literature Review. Clin Med Res. 2019; 17(1-2):29-33. PMC: 6546281. DOI: 10.3121/cmr.2019.1417. View

Johnson T, Jirik F, Fournier S . Exploring the roles of CD8(+) T lymphocytes in the pathogenesis of autoimmune demyelination. Semin Immunopathol. 2010; 32(2):197-209. DOI: 10.1007/s00281-010-0199-7. View

Cuzzubbo S, Javeri F, Tissier M, Roumi A, Barlog C, Doridam J . Neurological adverse events associated with immune checkpoint inhibitors: Review of the literature. Eur J Cancer. 2017; 73:1-8. DOI: 10.1016/j.ejca.2016.12.001. View

Brahmer J, Lacchetti C, Schneider B, Atkins M, Brassil K, Caterino J . Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2018; 36(17):1714-1768. PMC: 6481621. DOI: 10.1200/JCO.2017.77.6385. View

Pittet C, Newcombe J, Antel J, Arbour N . The majority of infiltrating CD8 T lymphocytes in multiple sclerosis lesions is insensitive to enhanced PD-L1 levels on CNS cells. Glia. 2011; 59(5):841-56. PMC: 7165507. DOI: 10.1002/glia.21158. View

Maurice C, Schneider R, Kiehl T, Bavi P, Roehrl M, Mason W . Subacute CNS Demyelination after Treatment with Nivolumab for Melanoma. Cancer Immunol Res. 2015; 3(12):1299-302. DOI: 10.1158/2326-6066.CIR-15-0141. View

Mancone S, Lycan T, Ahmed T, Topaloglu U, Dothard A, Petty W . Severe neurologic complications of immune checkpoint inhibitors: a single-center review. J Neurol. 2018; 265(7):1636-1642. DOI: 10.1007/s00415-018-8890-z. View

Duraes J, Coutinho I, Mariano A, Geraldo A, Macario M . Demyelinating disease of the central nervous system associated with Pembrolizumab treatment for metastatic melanoma. Mult Scler. 2018; 25(7):1005-1008. DOI: 10.1177/1352458518803724. View

Puzanov I, Diab A, Abdallah K, Bingham 3rd C, Brogdon C, Dadu R . Managing toxicities associated with immune checkpoint inhibitors: consensus recommendations from the Society for Immunotherapy of Cancer (SITC) Toxicity Management Working Group. J Immunother Cancer. 2017; 5(1):95. PMC: 5697162. DOI: 10.1186/s40425-017-0300-z. View

10.

Cao Y, Nylander A, Ramanan S, Goods B, Ponath G, Zabad R . CNS demyelination and enhanced myelin-reactive responses after ipilimumab treatment. Neurology. 2016; 86(16):1553-6. PMC: 5573201. DOI: 10.1212/WNL.0000000000002594. View

11.

Oka T, Yamamoto Y, Okuda Y, Asakura T, Hatano K, Nakai Y . Renal cell carcinoma with central nervous system demyelination caused by nivolumab. IJU Case Rep. 2021; 4(1):44-48. PMC: 7784733. DOI: 10.1002/iju5.12234. View

12.

Pillonel V, Dunet V, Hottinger A, Berthod G, Schiappacasse L, Peters S . Multiple nivolumab-induced CNS demyelination with spontaneous resolution in an asymptomatic metastatic melanoma patient. J Immunother Cancer. 2019; 7(1):336. PMC: 6889661. DOI: 10.1186/s40425-019-0818-3. View