RT Journal Article
SR Electronic
T1 Cerebral vasculitis mimicking intracranial metastatic progression of lung cancer during PD-1 blockade
JF Journal for ImmunoTherapy of Cancer
JO J Immunother Cancer
FD BMJ Publishing Group Ltd
SP 46
DO 10.1186/s40425-017-0249-y
VO 5
IS 1
A1 Heinz Läubli
A1 Jürgen Hench
A1 Michal Stanczak
A1 Ingmar Heijnen
A1 Alexandros Papachristofilou
A1 Stephan Frank
A1 Alfred Zippelius
A1 Frank Stenner-Liewen
YR 2017
UL http://jitc.bmj.com/content/5/1/46.abstract
AB Background Stimulation of the immune system by targeting the PD-1/PD-L1 pathway can result in activation of anti-tumor immunity. Besides its clinical benefit immune checkpoint therapy leads to significant immune-related adverse events (irAEs). Some rare irAEs are not well described yet but are critical in patient management.Case presentation Here, we describe a case of autoimmune cerebral vasculitis/encephalitis after PD-1 inhibitor treatment for metastatic adenocarcinoma of the lung. Upon PD-1 blockade, the patient developed cerebral lesions, while having disease stabilization of extracranial metastases. Imaging suggested that the patient had new progressing brain metastases. Despite stereotactic irradiation the lesions progressed further. The largest lesion became symptomatic and had to be surgically resected. On examination, cerebral vasculitis was detected but not evidence of metastatic lung cancer. Analysis of the patient’s serum revealed the presence of antinuclear antibodies that were already present before starting PD-1 blockade. In addition, we also found anti-vascular endothelial antibodies in the serum.Conclusion This finding suggests that the patient had preformed autoantibodies and the checkpoint inhibitor induced a clinically relevant autoimmune disease. Taken together, encephalitic lesions in patients under PD-1/PD-L1 blockade can mimic metastatic brain lesions and this rare irAE has to be considered as a differential diagnosis in patients treated with immunotherapy.Abbreviations:ANAAntinuclear antibodiesirAEImmune-related Adverse eventMRIMagnetic resonance imagingPD-1Programmed Death-1PD-L1 or –L2Programmed Death Ligand-1 or -2TNFαTumor Necrosis Factor α