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Review
. 2023 Feb 14;9(3):e13725.
doi: 10.1016/j.heliyon.2023.e13725. eCollection 2023 Mar.

Evaluation and management of acute high-grade immunotherapy-related neurotoxicity

Marcelo Sandoval  1 , Adriana H Wechsler  1 , Zahra Alhajji  1 , Jayne Viets-Upchurch  1 , Patricia Brock  1 , Demis N Lipe  2 , Aisha Al-Breiki  3 , Sai-Ching J Yeung  1
Affiliations
Review

Evaluation and management of acute high-grade immunotherapy-related neurotoxicity

Marcelo Sandoval et al. Heliyon. .

Abstract

Immune checkpoint inhibitor monoclonal antibodies allow the host's immune system to attack tumors, which has revolutionized cancer care over the last decade. As the use of immune checkpoint inhibitors has expanded, so have autoimmune-like complications known as immune-related adverse events. These include the infrequent but increasingly more common, potentially deadly neurological immune related adverse events. When feeling acutely ill, patients will often seek care not from their oncologist but from their family physician, clinics, emergency, and urgent care sites, or other available providers. Thus, while assessing acutely ill cancer patients who are experiencing neurological symptoms, non-oncologists should be prepared to recognize, diagnose, and treat neurological immune related adverse events in addition to more familiar conditions. This narrative review is designed to update acute care clinicians on current knowledge and to present a symptom-based framework for evaluating and treating neurological immune related adverse events based on the leading immunotoxicity organizations' latest recommendations.

Keywords: Diagnosis; Emergency department; Immune checkpoint inhibitors; Immune-related adverse effects; Management; Nervous system.

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Conflict of interest statement

The authors declare the following conflict of interests: S.-C. Yeung reports grants from Bausch Health Companies, Inc., Assertio Therapeutics, Inc. (previously Depomed, Inc.), and Bristol-Myer Squibb, and expert panel member at Celgene, Inc. outside the submitted work. DN Lipe is employed by IQVIA Biotech. No potential conflicts of interest were disclosed by the other authors.

Figures

Fig. 1
Fig. 1
Signs and symptoms associated with specific neurological immune related adverse events and their anatomical site.
Fig. 2
Fig. 2
Algorithm for the diagnosis of specific neurological immune related adverse events.
See this image and copyright information in PMC

References

    1. Leach D.R., Krummel M.F., Allison J.P. Enhancement of antitumor immunity by CTLA-4 blockade. Science. 1996;271(5256):1734–1736. doi: 10.1126/science.271.5256.1734. - DOI - PubMed
    1. Twomey J.D., Zhang B. Cancer immunotherapy update: FDA-approved checkpoint inhibitors and companion diagnostics. AAPS J. 2021;23(2):39. doi: 10.1208/s12248-021-00574-0. - DOI - PMC - PubMed
    1. Marin-Acevedo J.A., Kimbrough E.O., Lou Y. Next generation of immune checkpoint inhibitors and beyond. J. Hematol. Oncol. 2021;14(1):45. doi: 10.1186/s13045-021-01056-8. - DOI - PMC - PubMed
    1. FDA approves anti-LAG3 checkpoint. Nat. Biotechnol. 2022;40:625. doi: 10.1038/s41587-022-01331-0. - DOI - PubMed
    1. Tawbi H.A., et al. Relatlimab and nivolumab versus nivolumab in untreated advanced melanoma. N. Engl. J. Med. 2022;386(1):24–34. doi: 10.1056/NEJMoa2109970. - DOI - PMC - PubMed