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23.08.2021 | Original Article

Characterization and management of neurological adverse events during immune-checkpoint inhibitors treatment: an Italian multicentric experience

verfasst von: Luca Diamanti, Alberto Picca, Paola Bini, Matteo Gastaldi, Enrico Alfonsi, Anna Pichiecchio, Eugenia Rota, Roberta Rudà, Francesco Bruno, Veronica Villani, Edvina Galiè, Alberto Vogrig, Mariarosaria Valente, Marco Zoccarato, Valentina Poretto, Bruno Giometto, Carolina Cimminiello, Michele Del Vecchio, Enrico Marchioni

Erschienen in: Neurological Sciences | Ausgabe 3/2022

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Abstract

Background

Neurological immune-related adverse events (nirAEs) are rare toxicities of immune-checkpoint inhibitors (ICI). With the increase of ICI oncological indications, their incidence is growing. Their recognition and management remain nevertheless challenging.

Methods

A national, web-based database was built to collect cases of neurological symptoms in patients receiving ICI and not attributable to other causes after an adequate workup.

Results

We identified 27 patients who developed nirAEs (20 males, median age 69 years). Patients received anti-PD1/PDL1 (78%), anti-CTLA4 (4%), or both (19%). Most common cancers were melanoma (30%) and non-small cell lung cancer (26%). Peripheral nervous system was mostly affected (78%). Median time to onset was 43.5 days and was shorter for peripheral versus central nervous system toxicities (36 versus 144.5 days, p = 0.045). Common manifestations were myositis (33%), inflammatory polyradiculoneuropathies (33%), and myasthenia gravis (19%), alone or in combination, but the spectrum of diagnoses was broad. Most patients received first-line glucocorticoids (85%) or IVIg (15%). Seven patients (26%) needed second-line treatments. At last follow-up, four (15%) patients were deceased (encephalitis, 1; myositis/myasthenia with concomitant myocarditis, 2; acute polyradiculoneuropathy, 1), while seven (26%) had a complete remission, eight (30%) partial improvement, and six (22%) stable/progressing symptoms. ICI treatment was discontinued in most patients (78%).

Conclusions

Neurological irAEs are rare but potentially fatal. They primarily affect neuromuscular structures but encompass a broad range of presentations. A prompt recognition is mandatory to timely withheld immunotherapy and administrate glucocorticoids. In corticoresistant or severely affected patients, second-line treatments with IVIg or plasmapheresis may result in additional benefit.

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Titel: Characterization and management of neurological adverse events during immune-checkpoint inhibitors treatment: an Italian multicentric experience
verfasst von: Luca Diamanti
Alberto Picca
Paola Bini
Matteo Gastaldi
Enrico Alfonsi
Anna Pichiecchio
Eugenia Rota
Roberta Rudà
Francesco Bruno
Veronica Villani
Edvina Galiè
Alberto Vogrig
Mariarosaria Valente
Marco Zoccarato
Valentina Poretto
Bruno Giometto
Carolina Cimminiello
Michele Del Vecchio
Enrico Marchioni
Publikationsdatum: 23.08.2021
Verlag: Springer International Publishing
Erschienen in: Neurological Sciences / Ausgabe 3/2022
Print ISSN: 1590-1874
Elektronische ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-021-05561-z

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