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Table 4 Characteristics and outcomes of patients with PNS, by types

From: Worsening and newly diagnosed paraneoplastic syndromes following anti-PD-1 or anti-PD-L1 immunotherapies, a descriptive study

Patient characteristicsParaneoplastic hypertrophic osteoarthropathy (n = 6 pts)Paraneoplastic encephalitis
(n = 6 pts)
Paraneoplastic dermatomyositis (n = 5 pts)
Patients with a pre-existing PNS214
Patients with a newly diagnosed PNS451
Clinical type• Hypertrophic osteoarthropathy (n = 6 pts)• Anti-Ma2 autoantibody encephalitis (n = 4 pts)
• Anti-neuron antibody encephalitis (n = 1 pt)
• Cortical myoclonus encephalitis (n = 1 pt)
• Seronegative dermatomyositis (n = 4 pts)
• Anti-TIF1-associated dermatomyositis (n = 1 pt)
Cancer type
 - NSCLC432
 - Pulmonary sarcomatoid carcinoma100
 - Renal carcinoma110
 - Mesothelioma010
 - Melanoma012
 - Neuroendocrine carcinoma001
Bone metastasis101
General outcome for the PNS following anti-PD1 or PD-L1 immunotherapy
 - No worsening101
 - Worsening113
 - Newly diagnosis of a PNS451
Highest CTCAE grade of PNS severity
 - Grade 1–2400
 - Grade ≥ 3265
Time interval between initiation of immunotherapy to worsening or new diagnosis of the PNS, median (range), months1.4 (0.5–5)2.6 (0.5–5.5)0.7 (0.5–0.9)
Antitumor response at the time of worsening or newly diagnosis of a PNS
 - CR001
 - PR041
 - SD520
 - PD100
 - Not evaluated002
Impact of paraneoplastic syndrome on immunotherapy, n
 - temporary discontinuation301
 - permanent discontinuation063
 - no discontinuation301
Paraneoplastic syndrome treatment
 First-line treatmentAll 5 patients received first-line treatment:
- Steroids (n = 3): complete resolution in one patient, partial resolution in two patients
- NSAIDs (n = 2): complete resolution in one patient, partial resolution in one patient
All 6 patients received first-line treatment:
- Steroids (n = 5): partial resolution in four patients, no resolution in one patient.
- Steroids plus immunoglobulins (n = 1): partial resolution in one patient three patients
All 4 patients received first-line treatment:
- Steroids (n = 2): partial resolution in two patients
- Steroids plus immunoglobulins (n = 2): partial resolution in one patient, no resolution in one patient.
 Second-line treatments (if required)Second-line treatment was required in one patient:
- Methotrexate: partial resolution in one patient.
Second-line treatment was required in five patients:
- Immunoglobulins (n = 2) partial response in two patients
- Cyclophosphamide (n = 1): partial resolution in one patient
- Rituximab (n = 1): partial resolution in one patient
- Plasma exchange (n = 1): partial resolution in one patient
Second-line treatment was required in four patients:
- Methotrexate (n = 3): partial resolution in three patients
- Plasma exchange plus methotrexate (n = 1): partial resolution in one patient.
 Persistent of PNS symptoms with a CTCAE grade > 1 at last follow-up, n (%)1 (20)5 (83)3 (75)
 PNS related death, n (%)03 (50)0
  1. CR Complete response, CTCAE Common Terminology Criteria for Adverse Events, NA Not available, NSAID Non-steroidal anti-inflammatory drug, NSCLC Non-small-cell lung carcinoma, PD Progressive disease, PNS Paraneoplastic syndrome, PR Partial response, Pt patient, SD Stable disease