Abstract
SummaryParaneoplastic neurologic syndromes(PNSs) caused by immune checkpoint inhibitors(ICIs) is rare and requires clinicians to differentiate between disease progression and immune-related adverse effects(irAEs). We hereby report the case of immune-related myelitis accompanied by positive paraneoplastic autoantibodies following durvalumab treatment for extensive-stage small cell lung cancer (ES-SCLC). A 70-year-old Chinese woman with ES-SCLC was administered durvalumab with etoposid-platinum(EP) as first-line treatment. Four cycles after treatment with EP plus ICI, she developed immune-related myelitis with positive paraneoplastic autoantibodies (CV2, SOX1, ZIC4). Spinal MRI showed diffuse abnormal signal shadow in the cervicothoracic spinal cord. She was discontinued for chemotherapy, and treated with high-dose steroids, intravenous immunoglobulin and plasmapheresis, maintenance therapy with steroids resulted in a favorable neurologic outcome. This is the first report of durvalumab-related PNSs. We supposed that the development of paraneoplastic myelitis was causally related to immune activation by durvalumab. Prompt diagnosis and therapeutic intervention are essential for the effective treatment of paraneoplastic myelitis.
Highlights
Small cell lung cancer (SCLC) is a deadly disease that represents about 15% of all lung cancers [1]
cerebrospinal fluid (CSF) tumor markers were all negative. She was diagnosed with immune-related myelitis. She was discontinued with chemotherapy and treated with high dose of steroids, intravenous immunoglobulin and plasmapheresis, maintenance therapy with small dose of steroids resulted in a favorable neurologic outcome
We present a case with paraneoplastic neurologic syndromes (PNSs) affecting the spinal cord in a extensive-stage small cell lung cancer (ES-SCLC) patient treated with durvalumab combined with etoposide-platinum chemotherapy
Summary
Small cell lung cancer (SCLC) is a deadly disease that represents about 15% of all lung cancers [1]. We report a patient with ES-SCLC treated with first-line durvalumab combined with etoposide-platinum for 4 cycles and developed immune-related myelitis with positive paraneoplastic autoantibodies. CSF tumor markers (carcinoembryonic antigen, squamous cell carcinoma) were all negative She was discontinued with chemotherapy and treated with high dose of steroids, intravenous immunoglobulin and plasmapheresis, maintenance therapy with small dose of steroids resulted in a favorable neurologic outcome. MRI showed that the morphology and signal of myelopathy were improved (Fig. 3) She underwent irinotecan-carboplatin chemotherapy for 3 cycles and her lesion in the right lower lobe were reduced. She did not complete fourth cycle of the chemotherapy due to grade 3 diarrhoea according to the Common Terminology Criteria for Adverse Events version 4.1. She had achieved PR according to results of imaging assessment
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