Anti-Hu antibodies may indicate a positive response to chemotherapy in paraneoplastic syndrome secondary to small cell lung cancer.
Paraneoplastic encephalomyelitis (PEM) is a form of neurological dysfunction caused by the remote effect of small cell lung cancer (SCLC) on the brain. In certain cases it is associated with the presence of Anti-Hu antibodies. Up to 65% of patients with SCLC and PEM, who have Anti-Hu antibodies present, die of neurological complications rather than tumour progression. Chemotherapy is not believed to be beneficial. We describe a 58-year-old lady who was bed-bound and significantly disabled from paraneoplastic cerebellar degeneration. Her serology confirmed the presence of Anti-Hu antibodies and SCLC was confirmed at bronchoscopy. Following six courses of chemotherapy her neurological symptoms have remarkably improved, both subjectively and objectively, such that she is now independently mobile with a walking frame. Her tumour is still evident on bronchoscopy. We suggest that people with SCLC who are significantly disabled by neurological symptoms, should be tested for serum anti-neuronal antibodies and if Anti-Hu antibody positive, anti-neoplastic treatment should be considered despite poor performance status.
Department of Anaesthesia, Royal Liverpool University Hospital, Marie Curie Centre, Liverpool, UK. claire@alandclaire.free-online.co.uk
Claire A
CA
Douglas
John
J
Ellershaw
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001323:Autoantibodies / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D018288:Carcinoma, Small Cell / Q000188:drug therapy* / Q000276:immunology; D051959:ELAV Proteins; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000276:immunology; D008875:Middle Aged; D009419:Nerve Tissue Proteins / Q000276:immunology*; D020361:Paraneoplastic Syndromes, Nervous System / Q000188:drug therapy / Q000276:immunology*; D018579:Patient Selection; D016601:RNA-Binding Proteins / Q000276:immunology*; D016896:Treatment Outcome
D001323:Autoantibodies; D015415:Biomarkers; D051959:ELAV Proteins; D009419:Nerve Tissue Proteins; D016601:RNA-Binding Proteins