Abstract Details

Title Characterization of Encephalopathy Associated with Immune Checkpoint Inhibitor Therapy

Topic Autoimmune Neurology

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 15-004

Objective To define clinical, imaging, and electroencephalographic (EEG) characteristics of patients with immune checkpoint inhibitor (ICI)-induced encephalopathy.

Background ICIs, a novel class of highly effective anti-tumor agents for refractory cancers of skin, lungs, and lymphatic system, induce severe neurological toxicities necessitating permanent termination of treatment. Thus, meningitis, autoimmune encephalitis, and seizures develop in 1% of all treated patients amounting to potentially thousands of cases annually. The pathogenesis of ICI-induced encephalopathy is unknown, and there are currently no strategies to predict this complication. To identify the common clinical signature of the immune-related central nervous system (CNS) toxicity, we reviewed the characteristics of patients with ICI-induced encephalopathy.

Design/Methods This is a retrospective chart review and analysis. The search criteria (history of treatment with ICI and completion of EEG) identified all adult patients between January 2013 and September 2018. The diagnosis of ICI-induced CNS toxicity was established or suspected following the exhaustive search for other causes of encephalopathy.

Results Out of 26 identified patients, 11 and 12 were excluded because their EEG were obtained prior to initiation of ICIs and their encephalopathy had other etiologies, respectively. Five patients met the inclusion criteria of CNS toxicity after initiation of nivolumab (1), ipilimumab (2), and pembrolizumab (2); they presented with confusion, seizures, or dyskinesia. The mean age was 55 years while the mean time from the initiation of ICI to the initial presentation was 13 (3-27) days. Brain imaging was unrevealing, and EEG demonstrated generalized slowing. CSF was obtained in 2 patients and revealed noninfectious meningitis in one. Two patients were treated with oral or intravenous steroids and showed transient improvement. All patients subsequently deteriorated and have expired.

Conclusions Encephalopathy is an ominous complication of the cancer therapy with ICI. While ancillary tests may be uninformative, the diagnosis should be suspected in all patients with acute deterioration of mental status.

Authors/Disclosures
Danmeng Wei, MBBS (Multicare Health System) PRESENTER	No disclosure on file
Olha Taraschenko, MD, PhD (University of Nebraska Medical Center)	The institution of Dr. Taraschenko has received research support from NIH. The institution of Dr. Taraschenko has received research support from DHSS LB606 Nebraska Stem Cell Grant . Dr. Taraschenko has received personal compensation in the range of $0-$499 for serving as a Speaker with AES.

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