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Abstract Details

Cranial Nerve Palsy as an Immune Related Adverse Event Associated with Immune Checkpoint Inhibitors: Clinical Features and Outcomes
Autoimmune Neurology
P3 - Poster Session 3 (12:00 PM-1:00 PM)
073

To describe the clinical characteristics of patients with cranial nerve palsies (CNP) associated with immune checkpoint inhibitors (ICIs). 

ICIs are associated with various immune related adverse events (irAE), including CNP.  

In this retrospective cohort study, adults who received ICI at Cleveland Clinic with cranial neuropathy ICD codes were identified. Chart review confirmed de novo CNP <4 months after last ICI dose. The Kaplan-Meier curve was used to compare survival between melanoma patients who received ICI with CNP irAE to those without irAE (n=420). 

17 patients were identified (59% female, median age 70, range 41-85) with ICI associated CNP. Cancers included; melanoma (11 [65%]), genitourinary (3 [18%]), lung (2 [12%]), laryngeal (1[6%]). CNPs included; facial (11, [65%]), optic (3, [18%]), abducens (1, [6%]), vestibulocochlear (1, [6%]), trochlear (1, [6%]). ICIs included; pembrolizumab (5 [29%], combined ipilimumab/nivolumab (5 [29%], nivolumab (4 [23%]), ipilimumab (2 [12%]) and nivolumab/relatlimab (1 [6%]). Symptoms emerged at median of 25 days (range 1-110) after the last ICI dose, and median of 96 days (range 12-546) and 6 cycles (IQR 3-9) from the initiation of ICI. 

There were 11 (69%) with available concurrent MRI with 5 (45%) demonstrating abnormal findings (enhancement of; IAC [2], facial and vestibulocochlear [1], oculomotor, trigeminal, bilateral facial [1] and brain metastatic disease [1]).  

Treatments included corticosteroids in 13, one patient had additional IVIG. Clinical outcomes included; complete resolution (6), partial improvement (7), permanent visual loss (2), permanent hearing loss (1) and recurrent facial nerve palsy (1). Of those treated, 7/13 [54%] improved.  Melanoma patients with CNP irAE compared to melanoma patients without irAE had improved survival (p=0.044). 

CNP can occur in a subset of patients treated with ICI and predominantly involves the unilateral facial nerve. The majority of patients had melanoma. Among those treated with corticosteroids, greater than half demonstrated improved outcomes. 

Authors/Disclosures
Saira Afzal, MD
PRESENTER
Dr. Afzal has nothing to disclose.
Yadi Li (Cleveland Clinic) No disclosure on file
Brittany Lapin No disclosure on file
Lucy Kennedy (Cleveland Clinic Foundation) No disclosure on file
Amy Kunchok, MBBS (Cleveland Clinic - Mellen Centre) Dr. Kunchok has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology:Open Access Journal .