Diagnosis and Differential Diagnosis of Neurological Adverse Events during Immune Checkpoint Inhibitor Therapy
Joint Authors
Stangel, Martin
Möhn, Nora
Mahjoub, Susann
Gutzmer, Ralf
Satzger, Imke
Beutel, Gernot
Ivanyi, Philipp
Golpon, Heiko
Wattjes, Mike P.
Skripuletz, Thomas
Source
Issue
Vol. 2020, Issue 2020 (31 Dec. 2020), pp.1-9, 9 p.
Publisher
Hindawi Publishing Corporation
Publication Date
2020-12-07
Country of Publication
Egypt
No. of Pages
9
Main Subjects
Abstract EN
Therapy with immune checkpoint inhibitors (ICIs) has improved overall survival and cancer-related morbidity of cancer treatment even in cancer entities with poor prognosis.
Since the approval of the first ICI, ipilimumab, for treatment of advanced melanoma by the Food and Drug Administration (FDA) in 2011, the spectrum of indications and approved ICIs has grown, rapidly.
Up to now, seven different ICIs for more than 20 indications are available.
However, their mechanisms of action can lead to immune-related adverse events (irAEs).
In particular, neurological irAEs are clinically relevant.
Although they are rare, an early and accurate diagnosis is challenging and neurological disease course and sequelae are potentially fatal.
Between 08/2017 and 03/2020, 31 patients received ICI treatment at Hannover Medical School and presented with neurological adverse events (N-irAEs).
Treated malignancies were metastatic melanoma, bronchial carcinoma, and urothelial cell carcinoma.
All patients received comprehensive neurological diagnostics including clinical examination and magnetic resonance imaging (MRI).
Cerebrospinal fluid (CSF) analysis was obtained in 21 patients and electroneurography was performed in 22 patients.
Although N-irAEs were suspected in all 31 patients, 11 patients had other conditions leading to neurological symptoms including tumor metastases in seven patients and hemorrhagic or ischemic stroke in four patients.
In the following, these patients are referred to as the differential diagnosis (DD) group.
Patients with N-irAEs suffered from immune mediated neuropathy (9/20), myositis and/or myasthenic syndrome (6/20), or encephalitis/cerebellitis (5/20).
Except for cell count, CSF results did not differ between the N-irAEs and the DD group.
Symptoms related to N-irAEs are rather unspecific potentially mimicking other tumor-related symptoms such as metastases.
Patients with malignancy are predominantly not treated by neurologists.
Because of the complexity of neurological symptoms, detailed neurological investigations in specialized institutions are necessary in patients with new neurological symptoms and need to be critically discussed with treating oncologists.
American Psychological Association (APA)
Möhn, Nora& Mahjoub, Susann& Gutzmer, Ralf& Satzger, Imke& Beutel, Gernot& Ivanyi, Philipp…[et al.]. 2020. Diagnosis and Differential Diagnosis of Neurological Adverse Events during Immune Checkpoint Inhibitor Therapy. Journal of Oncology،Vol. 2020, no. 2020, pp.1-9.
https://search.emarefa.net/detail/BIM-1189143
Modern Language Association (MLA)
Möhn, Nora…[et al.]. Diagnosis and Differential Diagnosis of Neurological Adverse Events during Immune Checkpoint Inhibitor Therapy. Journal of Oncology No. 2020 (2020), pp.1-9.
https://search.emarefa.net/detail/BIM-1189143
American Medical Association (AMA)
Möhn, Nora& Mahjoub, Susann& Gutzmer, Ralf& Satzger, Imke& Beutel, Gernot& Ivanyi, Philipp…[et al.]. Diagnosis and Differential Diagnosis of Neurological Adverse Events during Immune Checkpoint Inhibitor Therapy. Journal of Oncology. 2020. Vol. 2020, no. 2020, pp.1-9.
https://search.emarefa.net/detail/BIM-1189143
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references
Record ID
BIM-1189143