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- paraneoplastic neurological syndromes
- onconeural antibodies
- cancer treatment
- intravenous immunoglobulin
Paraneoplastic neurological syndromes (PNS) are immune-mediated complications of cancer, characterised by relentless progression. The mainstay of PNS treatment is the achievement of tumour remission,1 while immunotherapy provides only little additional benefit.2 3 However, in historical series, immunotherapy was initiated over 6 months after neurological onset and, at that stage, neuronal loss is already extensive and irreversible.
Among available immunotherapies, intravenous immunoglobulin (IVIg) has been used in single cases4 and in one retrospective series,3 showing some efficacy when administered timely.4 Based on these findings, we designed a prospective study to assess the efficacy and safety of early IVIg treatment in patients with PNS.
This prospective, multicentre, non-comparative, phase II clinical study was performed by the ‘Centre de Reference Français des Syndromes Neurologiques Paranéoplasiques’. Written informed consent was obtained from all participants. This trial is registered at ClinicalTrials.gov (NCT02343211).
Inclusion criteria were: (1) diagnosis of ‘definite’ PNS5; (2) anti-Hu, anti-Yo, or anti-CV2/CRMP5 antibodies in the serum and/or in the cerebrospinal fluid; (3) neurological symptom onset within 6 months; (4) modified Rankin Score (mRS) 2 or 3; (5) neurological deterioration over the last 3 weeks. Exclusion criteria were: (1) other concomitant immunotherapy; (2) absolute contraindications to IVIg (hypersensitivity to IVIg, selective IgA deficiency); (3) thrombophilia; (4) renal insufficiency (creatinine clearance <30 mL/min).
Enrolled patients received three cycles of IVIg (Privigen, 2 g/kg, every 4 weeks), followed by an interim evaluation. If the patient was stable or improved according to the primary outcome measure, three additional IVIg cycles were administered. If the patient deteriorated, IVIg was discontinued. Final evaluation was …
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