Abstract Details

Title CNS and PNS Manifestation in Immune Checkpoint Inhibitors: A Systematic Review

Topic Autoimmune Neurology

Presentation(s) P7 - Poster Session 7 (8:00 AM-9:00 AM)

Poster/Presentation
Number 9-004

Objective We conducted a systematic review to describe onset, clinical features, treatment, and outcomes of neurological immune related adverse events (irAEs).

Background Immunomodulatory therapies, including the use of immune checkpoint inhibitors (ICIs), have made a
profound impact on treatment of advanced cancers in recent decades. They inhibit the downregulation of immune response against the tumor antigens. However, it may also downregulate the body’s self antigen identifying mechanisms. This may give rise to several adverse effects. Neurologic irAEs due to the use of these agents are rare but may have fatal sequelae.

Design/Methods A literature search was conducted to identify all case reports (n = 168) and case series (n = 29) describing neurological irAEs (n = 255 patients). Patient demographics, clinical features, and clinical courses were extracted and used to assess statistical relationships between reported variables.

Results Of reports describing neurological irAEs of immune checkpoint inhibitor (ICI) use, the majority of cases were seen in men (66%) and patients above the age of fifty (85%) (p < 0.05). Disorders of the peripheral nervous system (PNS, 83%) were more common than central nervous system involvement (p < 0.001). Neuromuscular disorders were the most common type of neurological irAE (e.g. myasthenia gravis, 36%), followed by peripheral neuropathies (16 %), followed by all CNS disorders combined (15%). Neurological adverse effects were more likely to present within the first 5 doses of ICI treatment (p < 0.05). Most patients improved clinically, but 24% of cases were fatal. Mortality was more in patients with neuromuscular irAEs, such as myasthenia gravis and myositis (p < 0.05).

Conclusions This systematic review describes the largest collection of neurological irAEs to date including both CNS and PNS manifestations of ICIs. Our study recommends high vigilance during the initial doses of ICI administration, especially for neuromuscular disorders. This can help identify and prevent fatal outcomes.

Authors/Disclosures
Erum Khan (B.J.Medical College,Ahmedabad) PRESENTER	Ms. Khan has nothing to disclose.
Ashish Kumar Shrestha, MBBS (Lehigh Valley Health Network)	Dr. Shrestha has nothing to disclose.
Hannah E. Wilson, MD, PhD (UMN Department of Neurosurgery)	Ms. Wilson has nothing to disclose.
Shitiz K. Sriwastava, MBBS (UT Health Houston)	Dr. Sriwastava has nothing to disclose.

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