The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd. Unit 0409, Houston, TX, 77030, USA.
Department of Neuro-Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, USA.
J Neurol. 2020 Apr;267(4):1023-1025. doi: 10.1007/s00415-019-09666-6. Epub 2019 Dec 13.
Immune checkpoint inhibitors have made significant advances in available cancer treatment options towards progression-free and overall survival in cancer patients by potentiating own anti-tumor immune response. Anti-programmed death (PD-1) and anti-cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) have been increasingly associated with neurologic complications. LE is a rare complication and like many complications secondary to immunotherapy, there is no standard for evaluation and treatment. Anti-GAD65-associated LE has been associated with thymic carcinoma. We describe a patient who presented with progressive memory loss 2 weeks after her third cycle of Ipilimumab and Nivolumab with associated elevated Anti-GAD65 levels. Treatment with IVIG and PLEX led to complete resolution of her symptoms and improvement in her brain imaging and CSF findings.
免疫检查点抑制剂通过增强自身抗肿瘤免疫反应，在癌症患者的无进展生存期和总生存期方面，为癌症治疗提供了显著进展。抗程序性死亡（PD-1）和抗细胞毒性 T 淋巴细胞相关抗原 4（CTLA-4）与神经系统并发症的关联性日益增加。LE 是一种罕见的并发症，与许多免疫治疗相关的并发症一样，目前尚无评估和治疗的标准。抗谷氨酸脱羧酶 65（GAD65）相关的 LE 与胸腺癌有关。我们描述了一位患者，她在接受伊匹单抗和纳武单抗第三周期治疗后 2 周出现进行性记忆丧失，同时伴随 Anti-GAD65 水平升高。静脉注射免疫球蛋白（IVIG）和血浆置换（PLEX）治疗导致她的症状完全缓解，脑影像学和脑脊液检查结果改善。
