Neurology of cancer immunotherapy.
Cancer immunotherapy
Demyelinating disorders
Meningoencephalitis
Myelitis
NAEs
Neurological complications
Journal
Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
ISSN: 1590-3478
Titre abrégé: Neurol Sci
Pays: Italy
ID NLM: 100959175
Informations de publication
Date de publication:
Jan 2023
Jan 2023
Historique:
received:
23
04
2022
accepted:
22
07
2022
pubmed:
17
9
2022
medline:
10
1
2023
entrez:
16
9
2022
Statut:
ppublish
Résumé
Immunotherapy is nowadays considered a mainstay of cancer treatment, dramatically affecting the disease-free survival rate in several aggressive malignancies. Unfortunately, cancer immunotherapy can also trigger life-threatening autoimmune neurological complications named "neurological adverse effects" (NAEs). NAEs can affect both the central nervous system (CNS), as in ipilimumab-related aseptic meningitis, and the peripheral nervous system (PNS), as in nivolumab-induced myasthenia gravis. The incidence of NAEs is highly variable, ranging from 2 to 4% using checkpoint inhibitors to 50% using blinatumomab. Looking at these numbers, it appears clear that neurologists will soon be called more and more frequently to decide upon the best therapeutic strategy for a patient receiving immunotherapy and experiencing a NAE. Most of them can be treated or reverted withholding the offending drug and adding IVIg, plasmapheresis, or steroids to the therapy. Sometimes, however, for oncological reasons, immunotherapy cannot be stopped so the neurologist needs to know what countermeasures have proven most effective. Moreover, patients with a pre-existing autoimmune neurological disease (AID), such as myasthenia gravis or multiple sclerosis, might need immunotherapy during their life, risking a severe worsening of their symptoms. In that setting, the neurologist needs to properly counsel patients about the risk of a therapy-related relapse. In this article, we describe the most frequently reported NAEs and aim to give neurologists a practical overview on how to deal with them.
Sections du résumé
BACKGROUND
BACKGROUND
Immunotherapy is nowadays considered a mainstay of cancer treatment, dramatically affecting the disease-free survival rate in several aggressive malignancies. Unfortunately, cancer immunotherapy can also trigger life-threatening autoimmune neurological complications named "neurological adverse effects" (NAEs). NAEs can affect both the central nervous system (CNS), as in ipilimumab-related aseptic meningitis, and the peripheral nervous system (PNS), as in nivolumab-induced myasthenia gravis.
CURRENT EVIDENCE
UNASSIGNED
The incidence of NAEs is highly variable, ranging from 2 to 4% using checkpoint inhibitors to 50% using blinatumomab. Looking at these numbers, it appears clear that neurologists will soon be called more and more frequently to decide upon the best therapeutic strategy for a patient receiving immunotherapy and experiencing a NAE. Most of them can be treated or reverted withholding the offending drug and adding IVIg, plasmapheresis, or steroids to the therapy. Sometimes, however, for oncological reasons, immunotherapy cannot be stopped so the neurologist needs to know what countermeasures have proven most effective. Moreover, patients with a pre-existing autoimmune neurological disease (AID), such as myasthenia gravis or multiple sclerosis, might need immunotherapy during their life, risking a severe worsening of their symptoms. In that setting, the neurologist needs to properly counsel patients about the risk of a therapy-related relapse.
CONCLUSION
CONCLUSIONS
In this article, we describe the most frequently reported NAEs and aim to give neurologists a practical overview on how to deal with them.
Identifiants
pubmed: 36112276
doi: 10.1007/s10072-022-06297-0
pii: 10.1007/s10072-022-06297-0
pmc: PMC9816208
doi:
Substances chimiques
Nivolumab
31YO63LBSN
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
137-148Informations de copyright
© 2022. The Author(s).
Références
Eur J Pharmacol. 2009 Dec 25;625(1-3):41-54
pubmed: 19837059
J Hematol Oncol. 2016 Aug 15;9(1):70
pubmed: 27526682
BMJ. 2018 Nov 08;363:k4226
pubmed: 30409774
N Engl J Med. 2018 Jan 11;378(2):158-168
pubmed: 29320654
Neurol Neuroimmunol Neuroinflamm. 2018 Jan 11;5(2):e439
pubmed: 30465016
Cancer Treat Rev. 2021 Jun;97:102189
pubmed: 33872978
Blood Rev. 2019 Mar;34:45-55
pubmed: 30528964
Neuro Oncol. 2014 Apr;16(4):589-93
pubmed: 24482447
Nat Rev Neurol. 2017 Dec;13(12):755-763
pubmed: 29104289
Lung Cancer. 2020 May;143:36-39
pubmed: 32200139
J Immunother Cancer. 2019 May 22;7(1):134
pubmed: 31118078
Continuum (Minneap Minn). 2019 Dec;25(6):1712-1731
pubmed: 31794468
Nat Rev Cancer. 2021 Jun;21(6):360-378
pubmed: 33907315
Eur J Cancer. 2017 Mar;73:1-8
pubmed: 28064139
J Neurooncol. 2019 Oct;145(1):1-9
pubmed: 31452071
N Engl J Med. 2014 Oct 16;371(16):1507-17
pubmed: 25317870
Mult Scler. 2015 Apr;21(5):670
pubmed: 25257614
Clin Transl Oncol. 2019 Oct;21(10):1336-1342
pubmed: 30788836
J Clin Oncol. 2018 Jun 10;36(17):1714-1768
pubmed: 29442540
J Clin Oncol. 2014 Dec 20;32(36):4134-40
pubmed: 25385737
Oncologist. 2017 Jun;22(6):709-718
pubmed: 28495807
Clin Case Rep. 2019 Apr 01;7(5):935-938
pubmed: 31110718
Lancet Oncol. 2019 Jan;20(1):43-56
pubmed: 30522969
Ther Adv Drug Saf. 2021 Mar 29;12:20420986211004745
pubmed: 33854755
Front Neurol. 2021 Apr 30;12:655283
pubmed: 33995251
Neurol Clin Pract. 2017 Oct;7(5):455-456
pubmed: 29620070
Neurology. 2019 Sep 10;93(11):e1093-e1103
pubmed: 31405908
J Clin Oncol. 2012 Feb 20;30(6):e76-8
pubmed: 22203769
Ann Oncol. 2017 Feb 1;28(2):377-385
pubmed: 28426103
Nat Rev Clin Oncol. 2016 Feb;13(2):92-105
pubmed: 26391778
Int J Mol Sci. 2020 Apr 26;21(9):
pubmed: 32357515
Ther Adv Neurol Disord. 2018 Sep 14;11:1756286418799864
pubmed: 30245744
J Biomed Sci. 2017 May 25;24(1):35
pubmed: 28545567
Cancer Discov. 2015 Dec;5(12):1238-40
pubmed: 26637657
Front Oncol. 2021 Sep 02;11:664809
pubmed: 34540659
Clin Immunol. 2020 Apr;213:108377
pubmed: 32135278
Ann Intern Med. 2018 Jan 16;168(2):121-130
pubmed: 29297009
Neurology. 2018 Sep 4;91(10):e985-e994
pubmed: 30089619
Cancer Immunol Immunother. 2018 May;67(5):825-834
pubmed: 29487980
Pharmacol Ther. 2018 May;185:122-134
pubmed: 29269044
Ann Oncol. 2017 Mar 1;28(3):673-675
pubmed: 27993808
Neurologist. 2019 May;24(3):75-83
pubmed: 31045716
Onco Targets Ther. 2015 Jun 24;8:1567-74
pubmed: 26170691
Ann Hematol. 2019 Jan;98(1):159-167
pubmed: 30238148
World J Clin Oncol. 2021 Mar 24;12(3):150-163
pubmed: 33767971
J Thorac Oncol. 2017 Nov;12(11):1626-1635
pubmed: 28843363
Ann Neurol. 2016 Aug;80(2):294-300
pubmed: 27351142
Lancet. 2018 Aug 4;392(10145):382-383
pubmed: 30102167
Curr Neurol Neurosci Rep. 2018 Feb 1;18(1):3
pubmed: 29392441
N Engl J Med. 2015 Jul 9;373(2):123-35
pubmed: 26028407
J R Soc Med. 2004 Apr;97(4):207-8
pubmed: 15056754
N Engl J Med. 2018 Feb 1;378(5):449-459
pubmed: 29385376
Ann Oncol. 2019 Apr 1;30(4):582-588
pubmed: 30715153
J Med Toxicol. 2022 Jan;18(1):43-55
pubmed: 33821435
Neurology. 2017 Sep 12;89(11):1127-1134
pubmed: 28821685