Abstract Details

Title Neurological Adverse Effects Due to Programmed Death (PD-1) Inhibitors

Topic Neuro-oncology

Presentation(s) P1 - Poster Session 1 (5:30 PM-6:30 PM)

Poster/Presentation
Number 7-020

Objective

To investigate the frequency, clinical spectrum and outcome of neurological complications following PD-1 inhibitor administration.

Background

There is increasing use of novel Programmed Death (PD-1) inhibitors, including pembrolizumab and nivolumab, for multiple oncological indications. Despite the approved use of PD-1 inhibition within several cancers, there remains a paucity of published literature reviewing the neurological adverse effects (nAEs) of PD-1 inhibitor use.

Design/Methods

This single-center, retrospective cohort study was conducted from patients treated September 2014 to August 2018. All patients who received PD-1 inhibitors were identified using the Stanford Medicine Research Data Repository (STARR), totaling 653 patients. Patients developing nAEs during or following PD-1 inhibitor treatment were reviewed. Patients with neurological symptoms attributable to metastatic disease to the brain or other concurrent treatments were excluded.

Results

- Among 650 patients treated with PD-1 inhibitors, 19 (2.9%) developed acute or subacute onset of nAEs. Ten were receiving pembrolizumab and 9 were receiving nivolumab (12 males and 7 females). Average age was 62.8 years, similar to those without nAEs (average 61.9 years). 17 patients had to stop PD-1 treatment permanently, while 2 patients stopped temporarily. Ten patients developed rapid onset of symptoms and death was referable to nAEs in 9 of the 19 patients. There was no correlation between time of onset and evolution of the nAE. Patients have significantly shorter duration of PD1 treatment (147 days vs 169.2 days) due to premature treatment termination. Symptoms were resolved after treatment and termination of PD-1 in 9 patients.

Conclusions

nAEs due to PD-1 inhibitors have diverse manifestations, frequently presenting as seizures, autoimmune encephalitis and neuromuscular complications such as muscle weakness and ataxia. Although nAEs are rare, they will likely increase in incidence as use of PD-1 inhibitors grows. Prompt recognition and discontinuation of PD-1 inhibitors by clinicians is crucial and patients should be counseled regarding risk of nAE.

Authors/Disclosures
Siyu Shi PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Reena P. Thomas, MD, PhD, FAAN (Stanford Medicine)	The institution of Dr. Thomas has received research support from NIH. The institution of Dr. Thomas has received research support from California Institute of Regenerative Medicine. Dr. Thomas has received intellectual property interests from a discovery or technology relating to health care.
	No disclosure on file

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