Severe meningo-radiculo-neuritis associated with ipilimumab.
OBJECTIVE
Ipilimumab is a T-cell-potentiating monoclonal antibody directed against cytotoxic T-lymphocyte antigen-4 (CTLA-4) to promote antitumoural immunity. In phase III trials, ipilimumab was shown to be the first agent to improve survival in advanced melanoma patients, regardless of previous treatment. We report a case of severe neurologic disease after ipilimumab treatment.


METHODS
Neurologic symptoms including facial diplegia, tetraplegia, areflexia progressed with time a few days after the fourth monthly ipilimumab infusion. Analysis of the cerebro-spinal fluid showed elevated proteinorachy and lymphocytic meningitis. Despite high doses of steroids and symptomatic treatment, the symptoms worsened.


RESULTS
Veinoglobulins were then infused and the patient began to improve and recovered almost normal activity two years later.


CONCLUSIONS
The adverse event profile associated with ipilimumab was primarily immune-related. This is the first case in which such a severe event has been reported.
Service de neurologie, Hôpital d'instruction des armées du Val de Grâce, Service de santé des Armées, Paris, France.
Flavie
F
Bompaire
Christine
C
Mateus
Hervé
H
Taillia
Thierry
T
De Greslan
Marion
M
Lahutte
Magali
M
Sallansonnet-Froment
Madani
M
Ouologuem
Jean-Luc
JL
Renard
Guy
G
Gorochov
Caroline
C
Robert
Damien
D
Ricard
D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D006801:Humans; D000074324:Ipilimumab; D008297:Male; D008545:Melanoma / Q000188:drug therapy; D008875:Middle Aged; D020258:Neurotoxicity Syndromes / Q000175:diagnosis*; D012878:Skin Neoplasms / Q000188:drug therapy
D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D000074324:Ipilimumab