Multiple nivolumab-induced CNS demyelination with spontaneous resolution in an asymptomatic metastatic melanoma patient

• Main Authors: Vincent Pillonel, Vincent Dunet, Andreas F. Hottinger, Gregoire Berthod, Luis Schiappacasse, Solange Peters, Olivier Michielin, Veronica Aedo-Lopez
• Format: Article
• Language: English
• Published: BMJ Publishing Group 2019-12-01
• Series: Journal for ImmunoTherapy of Cancer
• Subjects: Immune checkpoint inhibitors; Nivolumab; Immune related adverse events; Neurological toxicities; CNS demyelination; Metastatic melanoma
• Online Access: http://link.springer.com/article/10.1186/s40425-019-0818-3

Abstract Background Immune checkpoint inhibitors (ICPis) have revolutionised the treatment of melanoma by significantly increasing survival rates and disease control. However, ICPis can have specific immune-related adverse events, including rare but severe neurological toxicity. Case presentation 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. 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 favourable evolution.