Yamanaka Nanami, Oishi Mariko, Shimizu Fumitaka, Koga Michiaki, Kanda Takashi
Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine.
Rinsho Shinkeigaku. 2021 Oct 28;61(10):653-657. doi: 10.5692/clinicalneurol.cn-001562. Epub 2021 Sep 25.
A 76-year-old man, who received atezolizumab for the treatment for small cell lung cancer, acutely developed limb weakness with sensory disturbance after the third course of the treatment. Nerve conduction studies were consistent with demyelinating polyneuropathy and acute demyelinating polyneuropathy caused by atezolizumab was suggested. Atezolizumab was immediately withdrawn, and intravenous immunoglobulin (IVIg) and methylprednisolone pulse therapies with subsequent oral administration of prednisolone were initiated, after which neurological deficits steadily improved. Although Guillain-Barré syndrome-like neuropathy caused by immune checkpoint inhibitor (ICI) was occasionally reported, this is the first case of acute demyelinating polyneuropathy triggered by atezolizumab, monoclonal antibody targeting programmed death-ligand 1. This case suggests that combined treatments with IVIg and corticosteroids are effective for neuropathy induced by atezolizumab as same as those by other ICI.
一名76岁男性因小细胞肺癌接受阿替利珠单抗治疗,在第三个疗程后急性出现肢体无力并伴有感觉障碍。神经传导研究结果与脱髓鞘性多发性神经病相符,提示为由阿替利珠单抗引起的急性脱髓鞘性多发性神经病。立即停用阿替利珠单抗,并开始静脉注射免疫球蛋白(IVIg)和甲泼尼龙冲击治疗,随后口服泼尼松龙,此后神经功能缺损稳步改善。尽管偶尔有关于免疫检查点抑制剂(ICI)引起格林-巴利综合征样神经病的报道,但这是第一例由靶向程序性死亡配体1的单克隆抗体阿替利珠单抗引发的急性脱髓鞘性多发性神经病。该病例表明,IVIg和皮质类固醇联合治疗对阿替利珠单抗诱导的神经病与其他ICI诱导的神经病一样有效。