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

@article{Romeo2019MultipleSA,
  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},
  year={2019},
  volume={266},
  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… 

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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.

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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.

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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.