Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0278883 (metastatic melanoma)
 6,224 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Ipilimumab, a monoclonal antibody targeting human cytotoxic T-lymphocyte-associated antigen 4, was approved by the FDA and European Medicines Agency for the treatment of metastatic melanoma. Immune-related adverse effects can occur with the use of this agent, but peripheral nervous system problems are rare. We report 2 cases of ipilimumab-induced polyneuropathy.
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PMID:Peripheral neuropathy associated with ipilimumab: a report of 2 cases. 2565 17

The augmented immune response caused by immune checkpoint inhibitors leads to the emergence of a class of side effects called immune-related adverse events (irAEs). Facial palsy (FP) is rarely reported as an irAE. In this retrospective study, we reviewed the records of 353 patients treated with immunotherapy in our center from 2015-2018. We identified 4 male patients and 1 female patient with FP. Four had metastatic melanoma and were treated with ipilimumab either as monotherapy or in combination with nivolumab or pembrolizumab. The remaining patient had metastatic bladder cancer, treated with atezolizumab. FP was unilateral and occurred 1-23 weeks after starting immunotherapy. FP was part of a more diffuse neuropathic process in 3 of our patients. Lymphocytic pleocytosis was seen in the cerebrospinal fluid of 3 patients who had lumbar punctures. Magnetic resonance imaging showed enhancement of the intracranial portion of the affected facial nerve in 4 patients. The outcome was favorable in all of the patients noting that 1 patient had incomplete recovery. We conclude that FP, in isolation or as a part of a polyneuropathy, is common among neurological irAEs associated with checkpoint inhibitors and generally has a good prognosis.
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PMID:Facial Palsy Induced by Checkpoint Blockade: A Single Center Retrospective Study. 3061 17

By targeting receptors that serve to downregulate the cellular immune system, monoclonal antibodies such as ipilimumab and nivolumab have transformed the management of metastatic melanoma, and their use is referred to as immune checkpoint therapy (ICT). However, because the antitumoral activity of these agents is achieved through the reversal of mechanisms that naturally serve to temper the immune response, the potential for adverse reactions secondary to autoimmunity is of clinical significance. Neurological immune-related adverse events (irAEs) may occur consequent to ICT, and the development of autoimmune Bell's palsy is a specific, uncommon manifestation of the body's immune response against the seventh cranial nerve, resulting in acute paresis of facial muscles. We describe 2 cases of autoimmune Bell's palsy following the administration of combination ICT using ipilimumab and nivolumab in 2 patients with metastatic melanoma. The use of a steroid taper in addition to the cessation of combination immunotherapy resulted in resolution of symptoms for both patients. In the first case, the patient was subsequently started on nivolumab monotherapy but developed autoimmune polyneuropathy, and immunotherapy was discontinued indefinitely. In the second case, the initiation of nivolumab monotherapy following resolution of symptoms resulted in an inadequate antitumoral response. Subsequent transition to treatment with encorafenib/binimetinib initially provided a positive response but also required discontinuation secondary to irAEs. Both of these cases demonstrate the potential for autoimmune Bell's palsy as a consequence of combination ICT and provide evidence of successful treatment of this irAE through temporary discontinuation of immunotherapy and administration of steroids.
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PMID:Autoimmune Bell's Palsy Following Immunotherapy For Metastatic Melanoma: A Report of 2 Cases. 3131 23