Journal of Neurology

, Volume 266, Issue 12, pp 3163–3166 | Cite as

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

  • Marzia Anita Lucia Romeo
  • Marina Chiara Garassino
  • Lucia Moiola
  • Giulia Galli
  • Giancarlo Comi
  • Vittorio Martinelli
  • Massimo FilippiEmail author
Letter to the Editors

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 directed at a variety of cancers [1]. 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 [2]. 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...


Author contributions

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).

Ethical standards

A written informed consent was obtained from the patient for the publication of this case.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Neurology UnitIRCCS San Raffaele Scientific InstituteMilanItaly
  2. 2.Department of Medical OncologyFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
  3. 3.Department of Neurophysiology, Institute of Experimental Neurology, Division of NeuroscienceIRCCS San Raffaele Scientific InstituteMilanItaly
  4. 4.Neuroimaging Research Unit, Institute of Experimental Neurology, Division of NeuroscienceIRCCS San Raffaele Scientific InstituteMilanItaly
  5. 5.Vita-Salute San Raffaele UniversityMilanItaly

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