Ipilimumab ( Yervoy ) is a novel FDA-approved recombinant human monoclonal antibody that blocks cytotoxic T-lymphocyte antigen-4 and has been used to treat patients with metastatic melanoma.
Immune-related neurological adverse effects include inflammatory myopathy, aseptic meningitis, posterior reversible encephalopathy syndrome, Guillain-Barré syndrome, myasthenia gravis-type syndrome, sensorimotor neuropathy, and inflammatory enteric neuropathy.
To date, there is no report for Ipilimumab-induced chronic inflammatory demyelinating polyneuropathy ( CIDP ), transverse myelitis ( TM ), or concurrent myositis and myasthenia gravis-type syndrome.
Researchers have reported 3 cases of metastatic melanoma treated with Ipilimumab in which the patients developed chronic inflammatory demyelinating polyneuropathy, transverse myelitis, and concurrent myositis and myasthenia gravis-type syndrome, respectively, at the MD Anderson Cancer Center between July 2012 and June 2013.
The 3 cases of metastatic melanoma treated with Ipilimumab developed chronic inflammatory demyelinating polyneuropathy, transverse myelitis and concurrent myositis and myasthenia gravis-type syndrome, respectively.
The median time to onset of immune-related adverse events following ipilimumab treatment ranged from 1 to 2 weeks.
Ipilimumab was discontinued due to the severe neurological symptoms. Plasmapheresis was initiated in the patients with chronic inflammatory demyelinating polyneuropathy and concurrent myositis and myasthenia gravis-type syndrome; high-dose intravenous steroids were given to the patient with transverse myelitis, and significant clinical response was demonstrated.
In conclusion, Ipilimumab could induce a wide spectrum of neurological adverse effects. The findings support the standard treatment of withholding or discontinuing Ipilimumab.
Plasmapheresis or high-dose intravenous steroids may be considered as the initial choice of treatment for severe Ipilimumab-related neurological adverse events.
Improvement of neurological symptoms may be seen within two weeks. ( Xagena )
Liao B et al, Neuro Oncol 2014;16:589-593