Introduction: Immunotherapy using checkpoint inhibitors has revolutionized the treatment of cancer, including melanoma by significantly increasing survival rates and disease control. However, despite their specific mechanism of action, checkpoint inhibitors can have specific immune-related adverse events, including rare but severe neurological toxicity.
Aim and methods: The objective of this work was to publish as 1st author a case report on an extraordinary clinical case presenting with specific immune checkpoint inhibitor related adverse events. I first perform a concise literature review on cancer immunotherapy and its toxicities, with special emphasis on immune checkpoint inhibitors. After careful review of the literature I collected, analyzed and interpreted all clinical data relevant for the publication and then wrote and revised the manuscript.
Results: We report a 44-year-old man diagnosed with stage IIIB melanoma who developed metastatic disease (pulmonary and brain metastases) and was treated with stereotactic radiosurgery and nivolumab immunotherapy. He developed asymptomatic multifocal diffuse white matter lesions consistent with active central nervous system demyelination seen on brain MRI. One month after cessation of the immunotherapy, spontaneous regression of the demyelinating lesions was observed, suggesting a nivolumab-related toxicity.
Discussion and conclusion: We report the first case of a melanoma patient with an asymptomatic and spontaneously reversible central nervous system demyelination following nivolumab immunotherapy. This case highlights the need for better recognition of such atypical and rare neurological toxicities which could be mistaken for progressive brain metastases. Early recognition and appropriate management are crucial to reduce severity and duration of these toxicities, especially for patients with less favorable evolution. This case report has been recently published in the Journal of ImmunoTherapy of Cancer (Pillonel et al. J Immunother Cancer. 2019 Dec 2;7(1):336).