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Abstract Details

Acute polyradiculoneuropathy due to small molecule protein kinase inhibitors in cancer treatment
Neuromuscular and Clinical Neurophysiology (EMG)
P13 - Poster Session 13 (5:30 PM-6:30 PM)
1-007
To characterize peripheral nerve complications associated with small molecule protein kinase inhibitors.
Discovery of specific oncogenic mutations in numerous cancers has led to development of targeted therapies that improve morbidity and mortality. Small molecule protein kinase inhibitors (PKI) are now FDA-approved for cancers such as acute myeloid leukemia (AML) and melanoma. Neurologic side effects from these agents are not well known. We present three cases of drug-induced polyradiculoneuropathy from novel protein kinase inhibitors (PKI) used to treat acute lymphocytic leukemia (ALL), AML and metastatic melanoma.
Retrospective review of three cases.
From April 2017 to August 2019, three patients (P1, P2 and P3) presented with subacute leg paresthesias, pain and weakness, which temporally correlated with initiation of PKI for treatment of ALL, AML and metastatic melanoma, respectively. Two of three patients were men and age range at onset was 68 to 79 years. Time from drug initiation to symptom onset was 3 weeks to 5 months.  EMG revealed a non-length dependent polyradiculoneuropathy in all cases that was axonal in P1 and P2, and demyelinating in P3. Alternative causes of neuropathy were excluded with extensive evaluation including MRI lumbosacral plexus, serology with paraneoplastic panel, CSF analysis with cytology, and PET CT for occult malignancy. No immediate change in symptoms was seen with withdrawal/removal of the PKI, but all patients improved with a 5-day course of IV immune globulin (IVIG).
This is the first reported case series of polyradiculoneuropathy due to PKI treatment.  While the mechanism remains unknown, an immune-mediated etiology is possible given the response to IVIG. With the growing use of PKIs, polyradiculoneuropathy may increasingly be recognized as part of the spectrum of neuropathic complications of these new treatments.
Authors/Disclosures
Sara J. Doyle, MD (Northwestern University, McGaw Medical Center)
PRESENTER 		No disclosure on file
No disclosure on file
Karan S. Dixit, MD (Northwestern University) Dr. Dixit has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Servier.
Jinny O. Tavee, MD (National Jewish Health) Dr. Tavee has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for CSL Behring. Dr. Tavee has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Johnson and Johnson. Dr. Tavee has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Dynamed. The institution of Dr. Tavee has received research support from Woolsey. The institution of Dr. Tavee has received research support from Milken Foundation. The institution of Dr. Tavee has received research support from CSL Behring. Dr. Tavee has received personal compensation in the range of $0-$499 for serving as a Article author with Medlink.