Treatment Considerations for Patients with Unresectable Metastatic Melanoma Who Develop Pembrolizumab-Induced Guillain-Barré Toxicity: A Case Report
Open Access
- 21 January 2020
- journal article
- research article
- Published by S. Karger AG in Case Reports in Oncology
- Vol. 13 (1), 43-48
- https://doi.org/10.1159/000504930
Abstract
Immunotherapy has improved outcomes in many malignancies, most notably in melanoma, lung cancer, and bladder cancer. Understanding the side effects associated with these medications is an important part of managing our patients. Although fatigue, rash, and diarrhea are commonly reported side effects, it is important to be cognizant of rarer ones, such as neuropathy. Amongst the different neurological toxicities that have been reported in the literature, Guillain-Barre-like neuropathies are quite rare. However, the occurrence of such neuropathies in a patient can be life threatening. The problem this poses in treating cancers such as melanoma is that it eliminates an effective class of medication available to the patient, which can ultimately affect their prognosis. We present a case of a 65-year-old female with unresectable metastatic melanoma who developed Guillain-Barre-like neuropathy after two doses of pembrolizumab. Her clinical course was complicated by three separate hospitalizations over 3 months due to recurring bouts of neuropathy, which resulted in a significant decline in performance status and delay in subsequent treatment of her melanoma. Her prolonged recovery eventually resulted in progression of her melanoma nearly 1 year later, while off therapy. Instead of discontinuing immunotherapy completely, she agreed to a re-challenge with ipilimumab. After one dose, her melanoma regressed and continues to show a sustained response nearly 1 year after treatment without any signs of relapse in her neuropathy. Guillain-Barre toxicity resulting from immune checkpoint inhibition poses a difficult challenge to an oncologist who is determining the next line of treatment for patients with unresectable metastatic melanoma that have progressed while off therapy and who have no targetable mutations. Our case raises the question of whether a re-challenge with a different class of immunotherapy agent is a reasonable option.Keywords
This publication has 18 references indexed in Scilit:
- Immune-Related Adverse Events Associated with Immune Checkpoint InhibitorsBioDrugs, 2016
- Pembrolizumab versus Chemotherapy for PD-L1–Positive Non–Small-Cell Lung CancerNew England Journal of Medicine, 2016
- Pembrolizumab-Induced Demyelinating PolyradiculoneuropathyNew England Journal of Medicine, 2016
- Effect of nivolumab on health-related quality of life in patients with treatment-naïve advanced melanoma: results from the phase III CheckMate 066 studyAnnals Of Oncology, 2016
- Nivolumab-induced chronic inflammatory demyelinating polyradiculoneuropathy mimicking rapid-onset Guillain–Barré syndrome: a case reportJapanese Journal of Clinical Oncology, 2016
- Toxicities of the anti-PD-1 and anti-PD-L1 immune checkpoint antibodiesAnnals Of Oncology, 2015
- Neurological immune-related adverse events of ipilimumabPractical Neurology, 2013
- A Severe Case of Ipilimumab-Induced Guillain-Barré Syndrome Revealed by an Occlusive Enteric NeuropathyJournal of Immunotherapy, 2013
- Posterior Reversible Encephalopathy Syndrome During Ipilimumab Therapy for Malignant MelanomaJournal of Clinical Oncology, 2012
- Anti-CTLA-4 antibody-induced Guillain–Barré syndrome in a melanoma patientAnnals Of Oncology, 2011