LAUSR

Immunotherapy with the use of immune checkpoint inhibitors has emerged as a new pillar in cancer therapeutics. Nivolumab is an antibody targeting programmed cell death 1 (PD-1) signaling, which is approved for urothelial cancer treatment after failure of a platinum-based therapy. Immune checkpoint inhibitors have a unique mechanism of action among drugs used in cancer therapeutics, accompanied by a new class of adverse events, classified as immune-related adverse events. Toxicity from the neurological system is a rare presentation for patients treated with nivolumab. GuillainBarré syndrome (GBS) is an acute demyelinating polyneuropathy. Herein we report the first case of a male patient with urothelial cancer who received immune checkpoint inhibitor therapy with nivolumab and presented with GBS. A literature search for GBS related to nivolumab revealed 8 publications. Five of these referred to melanoma patients who received nivolumab monotherapy or nivolumab in combination with ipilimumab. The remaining 3 publications included patients who received nivolumab as monotherapy for nasal cancer, squamous-cell lung carcinoma, and nonesmall-cell lung cancer. The case reported here is the first case of urothelial cancer treated with nivolumab developing GBS. With the increasing use of immune checkpoint inhibitors, clinicians should be aware of immune-related adverse events. Symptoms from neurological system are rare, though they can occur at any time of anti ePD-1 and/or antieprogrammed death ligand 1 therapy. GBS presents with a rapid expansion of polyneuropathy. Administration of intravenous immunoglobulin and corticosteroids is the treatment of choice, which usually leads to symptom relief.