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Title: Clinical and radiological evolution of cerebral amyloid angiopathy-related inflammation in the context of anti-PD-1 immunotherapy.
Austin Authors: Lasocki, Arian;Kee, Damien 
Affiliation: Department of Medical Oncology, Austin Health, Heidelberg, Victoria, Australia
Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne
Department of Medicine, The University of Melbourne, Parkville
Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne
Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville
Issue Date: Dec-2020 2020-06-23
Publication information: Melanoma research 2020; 30(6): 608-612
Abstract: Immune-related adverse events (irAEs) are a frequent complication of immunotherapy, but neurological irAEs are rare and varied. Here, we present a case of cerebral amyloid angiopathy-related inflammation (CAA-ri) attributable to nivolumab monotherapy, which has not been previously reported. The context of immunotherapy and availability of serial imaging also provide unique insights into the pathogenesis and evolution of CAA-ri. Routine surveillance neuroimaging in a patient with metastatic melanoma, in remission after treatment with nivolumab, demonstrated progressive microhaemorrhages and associated oedema, suspicious for CAA-ri. These changes progressed despite cessation of nivolumab. The patient was initially asymptomatic, but later developed an acute confusional state, warranting brain biopsy, which confirmed the diagnosis of CAA-ri. Treatment with methylprednisolone resulted in resolution of the oedema, and a marked decrease in the subsequent accumulation of microhaemorrhages. The temporal evolution prior to symptom development and subsequently related to treatment suggests that inflammation may be an important component of the pathogenesis of CAA-ri, rather than simply a secondary response. Given that immunotherapy is in its relative infancy, it is important to consider rare irAEs in patients exhibiting unusual imaging findings.
DOI: 10.1097/CMR.0000000000000683
PubMed URL: 32590413
Type: Journal Article
Appears in Collections:Journal articles

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