Journal of

Case Reports and Images in Oncology

 
     
Case Series
 
Severe neurological side effects associated with ipilimumab: A case series
Muriel Richard1, Emilie Gerard1, Philippe Casenave1, Sorilla Prey1, Anne-Pham Ledard1, Diane Mermin1, Aurélia Gey1, Caroline Dutriaux1
1Department of Dermatology, National Reference Center for Rare Skin Disorders, University Hospital of Bordeaux, France

Article ID: 100036Z10MR2017
doi:10.5348/Z10-2017-36-CS-7

Address correspondence to:
Muriel Richard
Department of Dermatology, National Reference Center for Rare Skin Disorders,
University Hospital of Bordeaux
France

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How to cite this article:
Richard M, Gerard E, Casenave P, Prey S, Anne-Pham L, Mermin D, Gey A, Dutriaux C. Severe neurological side effects associated with Ipilimumab: A case series. J Case Rep Images Oncology 2017;3:29–34.


ABSTRACT
Introduction: Ipilimumab (IPI) is a T cell-potentiating monoclonal antibody used since 2011, directed against cytotoxic T-lymphocyte antigen-4 (CTLA-4) to promote anti-tumoral immunity. In phase II and III trials, IPI was shown to be the first agent to improve overall survival (OS) in advanced melanoma patients, regardless of previous treatment. Neurological immune-related adverse events (irAEs) associated with IPI are rare, multiple and often badly known. We report four new cases of severe neurological events during and after IPI treatment.
Case Series: We report four cases of metastatic melanomas with neurological irAEs induced by IPI in our dermatology department, between November 2014 and August 2015. Our four patients treated with IPI developed chronic inflammatory demyelinating polyneuropathy (CIDP), peripheral neuropathy, meningoencephalitis and aseptic meningitis respectively. In all, IPI was discontinued due to toxicity. High-dose intravenous steroids were given to all patients except in the patient who experienced aseptic meningitis. The one with CIDP also received intravenous immunoglobulins and plasmapheresis, without clinical improvement.
Conclusion: These four cases enrich the knowledge on neurological IPI induced-irAEs whose spectrum is wide and symptoms sometimes atypical. Early diagnosis and appropriate treatment are essential to minimize severe complications. Regarding our patients, these severe neurological irAEs were not predictive of an anti-tumoral response.

Keywords: Ipilimumab, Metastatic melanoma, Chronic inflammatory demyelinating polyneuropathy, Peripheral neuropathy, Aseptic meningitis, Neurologic immune-related adverse events


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Author Contributions
Muriel Richard – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Emilie Gerard – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Philippe Casenave – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Sorilla Prey – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Anne-Pham Ledard – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Diane Mermin – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Aurélia Gey – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Caroline Dutriaux – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2017 Muriel Richard et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.


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