Multiple sclerosis associated with pembrolizumab in a patient with non-small cell lung cancer

  title={Multiple sclerosis associated with pembrolizumab in a patient with non-small cell lung cancer},
  author={Marzia Romeo and Marina Chiara Garassino and Lucia Moiola and Giulia Galli and Giancarlo Comi and Vittorio Martinelli and Massimo Filippi},
  journal={Journal of Neurology},
  pages={3163 - 3166}
Dear Sirs, Pembrolizumab is a humanized IgG4 anti-programmed cell death-1 (PD-1) antibody serving as an immune-checkpoint inhibitor and proved long-lasting responses and prolonged survival for the treatment of advanced non-small cell lung cancer (NSCLC). PD-1 and its ligands (PD-L1 and PD-L2) are negative co-stimulatory molecules of T-cell activation. Pembrolizumab binds to the PD-1 receptor and blocks its interaction with PD-L1 and PD-L2, in this way, it enhances antitumor immune response… 

Neurological Diseases Associated to Immune Checkpoint Inhibitors

This bibliographic review brings the main neurological diseases associated with therapy, as well as the incidence, symptoms and treatment of monoclonal therapy and checkpoints inhibitors.

Central Nervous System Demyelination Associated With Immune Checkpoint Inhibitors: Review of the Literature

A systematic literature review of case reports with neurological immune adverse events that presented with central nervous system demyelination, up to December 2019, found 23 cases: seven with myelitis, four isolated optic neuritis, one neuromyelitis optica spectrum disorder, five multiple sclerosis, and six with atypical demYelination.

Neurologic disease activity in people with multiple sclerosis treated with immune checkpoint inhibitors.

ICPI use was not associated with increased clinical disease activity in this cohort of older patients with inactive MS and no patients had MS relapses after ICPI treatment or new MS lesions.


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Pembrolizumab versus Chemotherapy for PD-L1-Positive Non-Small-Cell Lung Cancer.

In patients with advanced NSCLC and PD-L1 expression on at least 50% of tumor cells, pembrolizumab was associated with significantly longer progression-free and overall survival and with fewer adverse events than was platinum-based chemotherapy.

Pembrolizumab Treatment for Progressive Multifocal Leukoencephalopathy

These findings are consistent with the hypothesis that in some patients with PML, pembrolizumab reduces JC viral load and increases CD4+ and CD8+ activity against the JC virus.

Multiple sclerosis outcomes after cancer immunotherapy

Reported MS relapses after ICI are rare, but the adverse events described include rapid neurologic progression and death, and larger and prospective studies are warranted to assess disability and long-term outcomes and outweigh the risks of starting immunotherapy in patients with MS.

Safety, activity, and immune correlates of anti-PD-1 antibody in cancer.

Anti-PD-1 antibody produced objective responses in approximately one in four to one in five patients with non-small-cell lung cancer, melanoma, or renal-cell cancer; the adverse-event profile does not appear to preclude its use.

Costimulatory Pathways in Multiple Sclerosis: Distinctive Expression of PD-1 and PD-L1 in Patients with Different Patterns of Disease1

The PD-1/PD-L1 pathway plays an important role in modulating immune functions in MS patients; monitoring and targeting these proteins could offer diagnostic and therapeutic advantages.

Immune-related adverse events for anti-PD-1 and anti-PD-L1 drugs: systematic review and meta-analysis

Organ specific immune-related adverse events are uncommon with anti-PD-1 drugs but the risk is increased compared with control treatments, and general adverse events related to immune activation are largely similar.

Neurologic complications of immune checkpoint inhibitors

This series highlights the very broad spectrum of neurological complications of ICPIs, emphasizes the need for expedited diagnosis and suggests that withholding treatment early, accompanied with steroid therapy, carries the potential of complete resolution of the neurological immune-mediated condition.