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02.08.2018 | Enzephalitis | Übersichten

Neurologische Nebenwirkungen von Checkpoint-Inhibitoren

verfasst von: S. Knauss, L. Ginesta Roque, P. Hühnchen, L. Heinzerling, PD Dr. W. Böhmerle, M. Endres

Erschienen in: Der Nervenarzt | Ausgabe 2/2019

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Zusammenfassung

Hintergrund

In den letzten Jahren wurde die Therapie zahlreicher Tumorentitäten durch den Einsatz moderner Immuntherapien mit Checkpoint-Inhibitoren revolutioniert. Guten Ansprechraten stehen jedoch zahlreiche immunvermittelte Nebenwirkungen gegenüber. Neurologische immunvermittelte Nebenwirkungen gehören zu den seltenen, jedoch häufig schwer verlaufenden Komplikationen einer Checkpoint-Inhibitor-Therapie.

Methode

Es wurde eine systematische Suche in den Datenbanken PubMed und Web of Science nach Fallberichten und Studien zu neurologischen Nebenwirkungen unter Checkpoint-Inhibitor-Therapie durchgeführt.

Ergebnisse

Insgesamt 42 Arbeiten zu neurologischen Nebenwirkungen von Checkpoint-Inhibitoren mit insgesamt 85 berichteten Fällen wurden identifiziert. Die häufigsten berichteten neurologischen Nebenwirkungen waren Myopathien, Neuropathien, Erkrankungen der neuromuskulären Endplatte und Enzephalitiden. Die höchste Morbidität und Mortalität wiesen Enzephalopathien und Myopathien mit begleitender Myokarditis auf.

Schlussfolgerung

Vor dem Hintergrund eines rasch zunehmenden Einsatzes von Checkpoint-Inhibitoren gibt diese Arbeit einen Überblick über bislang berichtete klinische Verlaufsformen neurologischer Nebenwirkungen. Kontrollierte Studien zur Therapie neurologischer Nebenwirkungen fehlen. Fallberichte lassen vermuten, dass eine frühzeitige Steroidtherapie die Wahrscheinlichkeit einer kompletten Remission der neurologischen Symptome erhöht. Typische Symptomkonstellationen müssen daher schnell erkannt und eine immunsuppressive Therapie eingeleitet werden.

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Titel: Neurologische Nebenwirkungen von Checkpoint-Inhibitoren
verfasst von: S. Knauss
L. Ginesta Roque
P. Hühnchen
L. Heinzerling
PD Dr. W. Böhmerle
M. Endres
Publikationsdatum: 02.08.2018
Verlag: Springer Medizin
Schlagwörter: Enzephalitis
Multiple Sklerose
Enzephalopathie
Myopathien
Checkpoint-Inhibitoren
Checkpoint-Inhibitoren
Erschienen in: Der Nervenarzt / Ausgabe 2/2019
Print ISSN: 0028-2804
Elektronische ISSN: 1433-0407
DOI: https://doi.org/10.1007/s00115-018-0571-8

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Die Einführung von Immun-Checkpoint-Inhibitoren markierte einen entscheidenden Fortschritt in der Behandlung von bestimmten Patienten mit nicht-kleinzelligem Lungenkarzinom (non-small cell lung cancer, NSCLC) und eröffnete seither neue Perspektiven und Chancen für Behandler und geeignete Patienten. Hier finden Sie fortlaufend aktuelle Informationen und relevante Beiträge zur Immunonkologie in dieser Indikation.

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