- Neurologic immune-related adverse events (NIrAEs) have been associated with use of immune checkpoint inhibitors (ICIs) for cancer therapy.
- NIrAEs occurred more often with the use of anti-CTLA-4.
Why this matters
- Clinicians need to recognize the variety of NIrAEs with use of ICIs and how to treat for best outcomes.
- NIrAEs may overlap with systemic adverse effects.
- Search of Massachusetts General Hospital database identified patients receiving ICIs June 2011-December 2017.
- Clinical data derived from patients’ medical records.
- 1851 patients received ICIs.
- 28 (1.5%) had grade 3/4 NIrAEs.
- Malignancies: 21 melanomas, 5 adenocarcinomas, 1 renal cell carcinoma,1 Hodgkin’s lymphoma.
- NIrAEs occurred more often with use of cytotoxic-T-lymphocyte-4 inhibitors alone (2.2%) or with programmed death-1 (PD-1) inhibitors or PD-1 ligand inhibitors (2.7%) vs anti-PD-1 monotherapy (1.0%).
- Immune-mediated central nervous system involvement occurred in 9 (28%) patients.
- 70% of NIrAEs occurred within 1-4 ICI cycles.
- Intravenous/oral corticosteroids were associated with favorable outcome (76% vs 24%, P<.05>
- Retreatment with ICIs associated with recurrent neurologic symptoms in 7 patients (P<.01>
- Data captured through December 2017.
- More recent practice may change NIrAE incidence.