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BACKGROUND Paraneoplastic syndromes traditionally precede tumor diagnosis. With recent greater use of immune checkpoint blockade therapy there is ever-increasing recognition of various immune related adverse effects. This abstract highlights PCA 1 paraneoplastic syndrome triggered by non-immune based chemotherapy, surgery, tumor recurrence and prior to development of second cancer. METHODS This is retrospective case review of patients seen at MD Anderson Cancer Center who developed PCA 1 paraneoplastic syndrome. RESULTS 64 yr old female with ovarian cancer on ERK inhibitor develops lower extremity weakness, ataxia and difficulty ambulation. Serum and CSF showed positive PCA-1 antibody. 59 yr old female with ovarian serous carcinoma develops cerebellar dysfunction after receiving caroboplatin and doxil. Serum and CSF were positive for PCA-1 antibody. 57 yr old female with ovarian carcinoma develops tremors, progressive ataxia after second cycle of carboplatin,taxol and avastin. Serum was positive for PCA-1 antibody. 45 yr old female with ovarian carcinoma completes 6 cycles of taxol and carboplatin. 3 months later develops gait ataxia. CSF was positive for PCA-1 antibody. Workup showed progressive ovarian carcinoma. 59 yr old with invasive ductal breast cancer develops lower extremity weakness and ataxia. Serum and CSF were positive for PCA-1 antibody. Work up revealed ovarian carcinoma. 63 yr old female with newly diagnosed breast cancer undergoes mastectomy. In the immediate postoperative time period develops diplopia, gait ataxia. Serum and CSF were positive for PCA-A antibody. All patients were aggressively treated with steroids. Most received additional therapies including plasma exchange, IVIG, tacrolimus, Rituxan, Cytoxan. All patients remained with permanent cerebellar dysfunction. CONCLUSIONS Case series highlights the recognition of paraneoplastic syndrome following traditional cytotoxic chemotherapy. There is need for early recognition of this neurological urgency. Work up includes prompt LP, serum and CSF paraneoplastic antibody panel, and evaluation for primary tumor recurrence or development of second cancer.

neuro-oncology

NCMP-26. RECOGNITION OF PARANEOPLASTIC SYNDROMES TRIGGERED BY TRADITIONAL CYTOTOXIC CANCER TREATMENT, TUMOR RECURRENCE AND DEVELOPMENT OF SECOND CANCER