Guillain-Barré Syndrome-Like Polyneuropathy Associated with Immune Checkpoint Inhibitors: A Systematic Review of 33 Cases.

Yan Li,Chuansheng Zhao,Xiuchun Zhang,Steven De Vleeschouwer

doi:10.1155/2021/9800488

Yan Li, Chuansheng Zhao + Show 2 more

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https://doi.org/10.1155/2021/9800488

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Abstract

Immune checkpoint inhibitors (ICIs) have been increasingly used in the treatment of various types of tumors with favorable results. But these treatments also led to a variety of immune-related adverse events (irAEs). Neurological irAEs such as Guillain-Barré Syndrome are rare and may have serious consequences once they occur. A systematic literature search was performed in PubMed and Embase for all case reports of GBS associated with ICIs published in English reporting on human beings from 1990 up to date. A total of 30 case reports (total patients = 33) were used for final analysis. The included cases were from 11 countries, covering 10 tumor types, with melanoma accounting for the largest number. The mean age was 62.2 ± 11.1 years old, and males were dominant (male: 26 and female: 7). The median time of initial symptoms was 8.2 weeks after the 1st dose of ICIs. The most common manifestations of GBS associated with ICIs were weakness, hyporeflexia or areflexia, and paresthesia in order. The GBS subtypes suggested by electrophysiological results were acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN), and Miller Fisher syndrome (MFS). The protein level of CSF in patients with GBS related to ICIs was 180.68 ± 152.51 mg/dl. Immediate termination of ICIs followed by intravenous immunoglobulin was the preferred treatment option. 72.7% of patients recovered or had residual mild dysfunction after treatment. Elderly male patients with melanoma were most likely to develop ICI-related GBS. The specific neurological symptoms, CSF analysis, and electrophysiological examination were important means of diagnosis.

Highlights

In the last decade, with a better understanding of the factors that promote or inhibit T cell response, great progress has been made on tumor immunotherapy
Immune checkpoint inhibitors (ICIs) have become a powerful clinical strategy for treating cancer, including an antibody targeting cytotoxic T lymphocyte-associated antigen-4 (CTLA-4, e.g., ipilimumab), antibodies directed against programmed cell death protein-1 (PD-1, e.g., nivolumab, pembrolizumab, and cemiplimab), and anti-Programmed cell death protein-1 PD-L1 (PD-1) ligand (PD-L1, e.g., atezolizumab, durvalumab, and avelumab) [1]
A systematic literature search was performed in PubMed and Embase for all case reports of GBS associated with ICIs published in English reporting on human beings from 1990 up to date

Summary

Introduction

With a better understanding of the factors that promote or inhibit T cell response, great progress has been made on tumor immunotherapy. Immune checkpoint inhibitors (ICIs) have become a powerful clinical strategy for treating cancer, including an antibody targeting cytotoxic T lymphocyte-associated antigen-4 (CTLA-4, e.g., ipilimumab), antibodies directed against programmed cell death protein-1 (PD-1, e.g., nivolumab, pembrolizumab, and cemiplimab), and anti-PD-1 ligand (PD-L1, e.g., atezolizumab, durvalumab, and avelumab) [1]. These drugs can be used alone or in combination with other immunotherapy [2] or chemotherapy [3] to improve the survival of cancer patients. The dermatologic, gastrointestinal, pulmonary, hepatic, and endocrine systems were most frequently involved

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