An autoimmune-based, paraneoplastic neurologic syndrome following checkpoint inhibition and concurrent radiotherapy for merkel cell carcinoma: case report.

Sherry AD, Bezzerides M, Khattab MH, Luo G, Ancell KK, Kirschner AN
Strahlenther Onkol. 2020 196 (7): 664-670

PMID: 32006066 · PMCID: PMC7306435 · DOI:10.1007/s00066-020-01582-3

PURPOSE - Merkel cell carcinoma is highly sensitive to both radiation and immunotherapy. Moreover, concurrent radioimmunotherapy may capitalize on anti-tumor immune activity and improve Merkel cell treatment response, although an enhanced immune system may cross-react with native tissues and lead to significant sequelae.

METHODS - Here we present a case study of a patient with metastatic Merkel cell carcinoma treated with radiotherapy concurrent with pembrolizumab.

RESULTS - After radioimmunotherapy, the patient developed sensory neuropathy, visual hallucinations, and mixed motor neuron findings. Neurologic dysfunction progressed to profound gastrointestinal dysmotility necessitating parenteral nutrition and intubation with eventual expiration.

CONCLUSION - This case represents a unique autoimmune paraneoplastic neurologic syndrome, likely specific to neuroendocrine tumors and motivated by concurrent radioimmunotherapy. Recognition of the potential role of radioimmunotherapy may provide an advantage in anticipating these severe sequelae.

MeSH Terms (27)

Aged Antibodies, Monoclonal, Humanized Antineoplastic Agents, Immunological Antineoplastic Combined Chemotherapy Protocols Autoimmune Diseases of the Nervous System Axilla Carboplatin Carcinoma, Merkel Cell Combined Modality Therapy Deglutition Disorders Etoposide Fatal Outcome Fingers Hallucinations Humans Lymphatic Metastasis Male Neuralgia Palliative Care Paraneoplastic Syndromes, Nervous System Parenteral Nutrition, Total Pneumonia, Aspiration Positron Emission Tomography Computed Tomography Radioimmunotherapy Radiotherapy, High-Energy Radiotherapy, Intensity-Modulated Skin Neoplasms

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