Abstract Details

Title Neurologic Immune-related Adverse Events of Immune Checkpoint Inhibitors

Topic Autoimmune Neurology

Presentation(s) P1 - Poster Session 1 (9:00 AM-5:00 PM)

Poster/Presentation
Number 053

Objective To determine the incidence and risk factors of neurologic immune-related adverse events (irAEs) in patients with cancer treated with immune checkpoint inhibitors (ICIs). To describe the effects of ICIs on pre-existing immune mediated neurologic conditions.

Background ICIs are an expanding class of cancer treatments but are associated with neurologic irAEs. Currently little is known about the risks for neurological irAEs and there is limited data regarding the effects of ICIs on pre-existing immune mediated neurologic conditions.

Design/Methods All adult patients with cancer who received an ICI from 01/2011-12/2019 at a single tertiary center were included. The overall incidence of neurologic irAEs was determined. Patients with neurologic irAEs were compared to patients without neurologic irAEs. Odds ratios were examined to identify potential predictors for developing neurologic irAEs.

Results 1243 patients (40.3% female, age 66.0 ±12.3, 89.3% white, 93.1% stage IV cancer) were exposed to ICI (83.3% PD-1/PD-L1, 1.7% CTLA-4, 15% combination) and 2.9% (n=36) developed a neurologic irAE. The most common neurologic irAEs were myasthenia with myositis (19%) and myasthenia without myositis (11%). Median time from initial exposure to complication was 106 days (interquartile range: 41-194). Melanoma (Odds ratio [OR] 5.6, p=0.002), prior resection (OR 2.6, p=0.010), CTLA-4 (OR 4.8, p=0.042), and combination ICI (OR 3.2, p=0.002) were associated with development of a neurological irAE. Subjects with irAE were less likely to have stage IV cancer (OR 0.35, p=0.025) and prior chemotherapy (OR 0.35, p=0.002). 14 patients (39%) were rechallenged with ICI after neurological irAE. 13 patients had a pre-existing immune mediated neurologic condition and 2 of these patients had an exacerbation after ICI exposure.

Conclusions Neurologic irAEs and exacerbation of pre-existing immune mediated neurologic conditions are rare after ICI exposure. Continued investigation of risk factors and the impact on pre-existing neurologic conditions is warranted to develop evidenced-based management strategies.

Authors/Disclosures
Chen Yan, MD (Cleveland Clinic) PRESENTER	Dr. Yan has nothing to disclose.
Merry Huang, MD (Cleveland Clinic)	Dr. Huang has nothing to disclose.
Carol Swetlik, MD (Cleveland Clinic)	An immediate family member of Dr. Swetlik has received personal compensation for serving as an employee of Pfizer. Dr. Swetlik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genetech. Dr. Swetlik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen.
Karlo Toljan, MD (Cleveland clinic)	Dr. Toljan has nothing to disclose.
	No disclosure on file
	No disclosure on file
Marisa P. McGinley, DO (Cleveland Clinic)	Dr. McGinley has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. McGinley has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. The institution of Dr. McGinley has received research support from Biogen. The institution of Dr. McGinley has received research support from Genentech. The institution of Dr. McGinley has received research support from NIH. The institution of Dr. McGinley has received research support from AHRQ. The institution of Dr. McGinley has received research support from EMD Serono.

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