Fatal encephalopathy after pembrolizumab treatment for advanced non-small cell lung carcinoma

  • Cláudia FreitasEmail author
  • Luísa Sampaio
  • Gabriela Fernandes
Letter to the Editor

To the Editor,

Pembrolizumab is a monoclonal antibody against programmed cell death 1 (PD-1) receptor approved for PD-L1 positive advanced non-small cell lung cancer (NSCLC) [1]. Neurologic adverse events associated with anti-PD1 antibodies are rare [2]. We report a case of fatal encephalopathy in a patient with advanced NSCLC treated with pembrolizumab.

A 65 year-old former smoker woman was diagnosed with advanced KRAS-mutant lung adenocarcinoma (T4N3M1b) with an intermediate expression of PD-L1 (20–30%). Her past medical history was unremarkable. She was treated with six cycles (every 3 weeks) of carboplatin (area under the concentration–time curve of 5.0 mg/mL/min) and pemetrexed (500 mg/m 2) with partial response and a maintenance pemetrexed regimen (500 mg/m 2) with stable disease for six months. After disease progression, pembrolizumab (200 mg, every 3 weeks) was started. Fourteen days after the second infusion of pembrolizumab, she presented with an episode of generalized...




Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest.

Ethical approval

The report of this case was approved by Ethics Committee of Centro Hospitalar e Universitário de São João.


  1. 1.
    Herbst RS, Baas P, Kim DW et al (2016) Pembrolizumab versus docetaxel for previously treated, PD-L1-positive, advanced non-small-cell lung cancer (KEYNOTE-010): a randomised controlled trial. Lancet. Google Scholar
  2. 2.
    Kao JC, Liao B, Markovic SN et al (2017) Neurological complications associated with anti–programmed death 1 (PD-1) antibodies. JAMA Neurol. Google Scholar
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    Feng S, Coward J, McCaffrey E et al (2017) Pembrolizumab-induced encephalopathy: a review of neurological toxicities with immune checkpoint inhibitors. J. Thorac, OncolGoogle Scholar
  4. 4.
    Maurice C, Schneider R, Kiehl T-R et al (2015) Subacute CNS demyelination after treatment with nivolumab for melanoma. Cancer Immunol Res. Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Pulmonology DepartmentCentro Hospitalar e Universitário São JoãoPortoPortugal
  2. 2.Neuroradiology DepartmentCentro Hospitalar e Universitário São JoãoPortoPortugal
  3. 3.Faculty of MedicineUniversity of PortoPortoPortugal

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