Objective: To present the first reported case of reversible, levodopa sensitive, chemotherapy- induced parkinsonism due to the combination of carboplatin, paclitaxel, and nivolumab.

Background: Many case reports describe antineoplastic agents causing reversible parkinsonism, most commonly, cyclophosphamide, cytosine arabinoside, and cyclosporine. To our knowledge, drug-induced parkinsonism related to combination therapy of paclitaxel, carboplatin, and nivolumab has never been reported.

Method: Case report from a tertiary medical center.

Results: A 42-year-old woman with a past medical history of breast cancer in remission and metastatic anal squamous cell carcinoma receiving paclitaxel, carboplatin, and nivolumab presented to the hospital for pseudomonal UTI. During hospitalization, she developed acute severe bradykinesia, hypophonia, dysphagia, and bilateral cogwheeling rigidity. At baseline, the patient was completely independent and functional. She received her 4^th cycle of chemotherapy 2 weeks prior to the onset of severe extrapyramidal symptoms. Notably, the patient was prescribed outpatient prochlorperazine for one year, which was continued while inpatient for 8 days until onset of symptoms.  Lumbar puncture and CTA head/neck were unrevealing. MRI of the brain was not performed due to an intrathecal fentanyl/buprenorphine pump for cancer related pain. After initiation of levodopa-carbidopa, she had improved speech production within 24 hours. She slowly regained spontaneous motor movement, normal tone, and swallowing with titration of levodopa-carbidopa, as well as time from exposure to chemotherapy.

Conclusion: Chemotherapy-induced parkinsonism is a rare condition which can produce significant morbidity if not identified and treated promptly. To our knowledge, this is the first case report of combined usage of carboplatin, paclitaxel, and nivolumab causing rapidly progressive parkinsonism responsive to levodopa. All three of these agents have been separately associated with reversible parkinsonism. An additive or synergistic interaction may explain this patient’s severe manifestation. Although her clinical picture is confounded by prochlorperazine usage, the extent of her extrapyramidal symptoms makes this unlikely to be the sole etiology.

« Back to MDS Virtual Congress 2021

MDS Abstracts - https://www.mdsabstracts.org/abstract/carboplatin-paclitaxel-and-nivolumab-induced-parkinsonism-responsive-to-levodopa/