Characterization and management of neurological adverse events during immune-checkpoint inhibitors treatment: an Italian multicentric experience
| Autor: | Bruno Giometto, Carolina Cimminiello, Paola Bini, Enrico Marchioni, Enrico Alfonsi, Marco Zoccarato, Eugenia Rota, Veronica Villani, Edvina Galiè, Anna Pichiecchio, Michele Del Vecchio, Alberto Vogrig, Roberta Rudà, Luca Diamanti, Valentina Poretto, Alberto Picca, Francesco Bruno, Mariarosaria Valente, Matteo Gastaldi |
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| Přispěvatelé: | Diamanti, L., Picca, A., Bini, P., Gastaldi, M., Alfonsi, E., Pichiecchio, A., Rota, E., Ruda, R., Bruno, F., Villani, V., Galie, E., Vogrig, A., Valente, M., Zoccarato, M., Poretto, V., Giometto, B., Cimminiello, C., Del Vecchio, M., Marchioni, E. |
| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
Male
medicine.medical_specialty Lung Neoplasms Myocarditis Neurology Immune-checkpoint inhibitor Neurological immune-related adverse events medicine.medical_treatment Immune Checkpoint Inhibitor Immune-checkpoint inhibitors Polyradiculoneuropathy Dermatology Internal medicine Carcinoma Non-Small-Cell Lung Neoplasms Neurotoxicity Humans Medicine Myositi Non-Small-Cell Lung Adverse effect Immune Checkpoint Inhibitors Myositis Aged Female Immunotherapy business.industry Carcinoma General Medicine medicine.disease Myasthenia gravis Neurological immune-related adverse event Lung Neoplasm Psychiatry and Mental health Concomitant Plasmapheresis Neurology (clinical) business Human |
| DOI: | 10.1007/s10072-021-05561-z |
| Popis: | 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 69years). 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 43.5days and was shorter for peripheral versus central nervous system toxicities (36 versus 144.5days, 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. |
| Databáze: | OpenAIRE |
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