Neurotoxicity and safety of the rechallenge of immune checkpoint inhibitors: a growing issue in neuro-oncology practice

Neurological, immune-related adverse events (n-irAE) due to immune checkpoint inhibitors (ICI) represent a growing clinical problem in neuro-oncology practice. Although rare, the frequency of n-irAEs will increase as ICI use becomes more common. Central and peripheral nervous systems may be involved...

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Bibliographic Details
Published in:Neurological sciences 2022-04, Vol.43 (4), p.2339-2361
Main Authors: Villagrán-García, M., Velasco, R.
Format: Article
Language:English
Subjects:
Cancer therapies
Clinical medicine
Decision making
Encephalitis
Encephalomyelitis
Heart diseases
Humans
Immune checkpoint inhibitors
Immune Checkpoint Inhibitors - adverse effects
Immunosuppressive agents
Immunotherapy
Inflammatory diseases
Medicine
Medicine & Public Health
Meningitis
Musculoskeletal diseases
Myasthenia
Myasthenia gravis
Myocarditis
Myositis
Neoplasms - drug therapy
Nervous system
Neurological complications
Neurology
Neuromuscular junctions
Neuroradiology
Neurosciences
Neurosurgery
Neurotoxicity
Neurotoxicity Syndromes - drug therapy
Oncology
Patients
Peripheral Nervous System
Psychiatry
Reintroduction
Retreatment
Review Article
The growing role for neurology in neuro-oncology
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Summary:Neurological, immune-related adverse events (n-irAE) due to immune checkpoint inhibitors (ICI) represent a growing clinical problem in neuro-oncology practice. Although rare, the frequency of n-irAEs will increase as ICI use becomes more common. Central and peripheral nervous systems may be involved, and multiple n-irAEs like myositis, myasthenia gravis, and myocarditis can arise in the same patient. Prompt recognition, initial ICI discontinuation, and treatment with immunosuppressive therapy comprise key aspects of managing these potentially fatal neurological complications. Severe and/or treatment-refractory n-irAEs may occur and require individualized care. In the same vein, a possible reintroduction of ICI after a n-irAE represents an additional challenge in clinical practice. An approach by experienced neurologists involved in highly subspecialized, multidisciplinary care teams is, therefore, of major importance in managing these cases. The present study updates current knowledge regarding presentation forms, diagnostic workflows, outcomes, and general management of n-irAEs. With the aim to guide neurologists in decision-making processes during such scenarios, the study further reviews available data on ICI reintroduction safety in patients with prior n-irAEs.
ISSN:1590-1874
1590-3478
DOI:10.1007/s10072-022-05920-4