Neurotoxicity: A Rare Side Effect of Programmed Cell Death 1 (PD-1) Inhibitors

Abstract

Immunotherapy is a biological therapy that helps the body's immune system to fight against cancer cells. The Food and Drug Administration (FDA) approved the first immune checkpoint inhibitor in 2011. Since 2011, many immune checkpoint inhibitors have been approved. Programmed cell death 1 (PD-1) inhibitors are now commonly used in multiple malignancies due to their remarkable response. Thus, immune-related adverse events are now coming into the limelight due to the increasing use of PD-1 inhibitors. Here, we present a case of a 54-year-old female with non-small cell lung cancers (NSCLC) treated with pembrolizumab and later presented with severe neurotoxicity.

Keywords: anti-pd-1; immuno-checkpoint inhibitor; immunotherapy adverse effect; lung cancer; non-small cell lung cancer (nsclc).

Figure 1. Pre-treatment axial T2 MRI demonstrating multifocal T2 hyperintense lesions involving left occipital (red arrow), right occipital (purple arrow), left frontal (yellow arrow), and right parietal lobe (green arrow) with associated perilesional edema and mass effect

Figure 2. Post-treatment axial T2 MRI image demonstrating the resolution of previously noted T2 hyperintense lesions with mild residual edema in bilateral occipital and left frontal lobes