Multiple sclerosis associated with pembrolizumab in a patient with non-small cell lung cancer
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 directed at a variety of cancers . In patients with PD-L1 > 50%, pembrolizumab has revolutionized the prognosis conferring a fourfold increase of survival compared to chemotherapy, with few, mainly immune-related side effects as consequence of deregulation of the response of T cells to antigens presented by normal cells . Neurological side effects, such as polyradiculitis, myasthenic syndrome and demyelinating disease of central nervous system (CNS), have been reported [3, 4, 5, 6]. In this...
Conceptualization: MALR; writing—original draft preparation: MALR; acquisition of data: MARL, MAG, LM, GG; interpretation of data: all authors; writing—review, and editing: all authors.
Compliance with ethical standards
Conflicts of interest
M. Romeo received honoraria from Sanofi Genzyme, Merck-Serono, and support for traveling from Novartis, Almirall and Teva Pharmaceutical Industries; M. Garassino received personal fees from AstraZeneca, Roche, BMS, MSD; L. Moiola received honoraria from Sanofi Genzyme, TEVA Pharmaceutical Industries, Novartis, Merck-Serono and Biogen Idec; G. Galli report no disclosures; G. Comi received compensation for consulting services and speaking activities from Novartis, Teva Pharmaceutical Industries, Sanofi Genzyme, Merck-Serono, Biogen Idec, Roche, Almirall, Celgene, Forward Pharma, Medday and Excemed; V. Martinelli received honoraria from Sanofi Genzyme, Biogen Idec, TEVA Pharmaceutical Industries, Bayer, Merck-Serono and Novartis; M. Filippi is Editor-in-Chief of the Journal of Neurology; received compensation for consulting services and/or speaking activities from Biogen Idec, Merck-Serono, Novartis, Teva Pharmaceutical Industries; and receives research support from Biogen Idec, Merck-Serono, Novartis, Teva Pharmaceutical Industries, Roche, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla, and ARiSLA (Fondazione Italiana di Ricerca per la SLA).
A written informed consent was obtained from the patient for the publication of this case.