1. Asymptomatic brainstem lesions and pachymeningeal enhancement after anti-PD-1 therapy
- Author
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Yuen, Carlen A, Rezania, Kourosh, Park, Deric M, and Reder, Anthony T
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Oncology and Carcinogenesis ,Immunology ,Cancer ,Rare Diseases ,Transplantation ,Aetiology ,2.1 Biological and endogenous factors ,Good Health and Well Being ,Adrenal Cortex Hormones ,Antibodies ,Monoclonal ,Humanized ,Brain Neoplasms ,Brain Stem ,Female ,Graft vs Host Disease ,Humans ,Immune Checkpoint Inhibitors ,Magnetic Resonance Imaging ,Male ,Meningitis ,Middle Aged ,Nivolumab ,Programmed Cell Death 1 Receptor ,Thymoma ,Thymus Neoplasms ,chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids ,CLIPPERS ,graft-versus-host-disease ,GVHD ,immune-related adverse events ,neuromyelitis optica ,nivolumab ,NMO ,pachymeningeal enhancement ,pembrolizumab ,Pharmacology and Pharmaceutical Sciences ,Oncology and carcinogenesis - Abstract
Neurological immune-related adverse events (irAEs) are rare toxicities that occur following immune checkpoint inhibitor therapy. We propose that patients with thymic malignancies and graft-versus-host disease (GVHD) are predisposed to irAEs. We present two asymptomatic patients, one with thymoma and another with GVHD, who developed abnormal brain MRIs after treatment with programmed cell death protein 1 inhibitors. The first patient, with thymic cancer and thymoma, developed pontine enhancing MRI lesions following treatment with pembrolizumab. The second patient, with prior GVHD, developed pachymeningeal enhancement following treatment with nivolumab. IrAEs with abnormal MRI studies, despite asymptomatology, have significant impact on the treatment strategy for these patients.
- Published
- 2021