Abstract Details

Title Predictors for the Development of Neurological Immune-related Adverse Events of Immune Checkpoint Inhibitors and Impact on Mortality

Topic Autoimmune Neurology

Presentation(s) C5 - Paraneoplastic Neurologic Syndromes and Neurologic Complications of Immune Checkpoint Inhibitor Cancer Immunotherapy (9:25 AM-9:30 AM)
P1 - Poster Session 1 (9:00 AM-5:00 PM)

Poster/Presentation
Number 051

Objective To report the incidence, predictors for development, impact on mortality, and impact on pre-existing neurological conditions of neurological immune-related adverse events (irAEs) in a large clinical cohort.

Background Immune checkpoint inhibitors (ICI) are associated with irAEs. Although neurological complications have been described, little is known about risk factors for their development and their impact on mortality. The impact of ICIs on pre-existing neurological conditions is also not well understood.

Design/Methods Patients who received ICI between January 2013 and December 2018 were identified using a tertiary cancer center registry. Patient demographics, cancer characteristics, treatment type, and concurrent oncologic therapy were summarized using descriptive statistics. Patients with neuro-irAE were compared to those without neuro-irAE during the study timeframe. Odds ratios from univariable and penalized multivariable logistic regression models were calculated to identify potential predictors for developing a neuro-irAE. The impact of a neuro-irAE on overall survival was estimated by Kaplan-Meier and multivariable Cox proportional-hazard models.

Results Overall frequency of neurological irAEs was 2.3% (28/1228). Peripheral nervous system complications such as myasthenia gravis, myositis, and neuropathies were the most frequent (53.6%). Melanoma, younger age, prior chemotherapy, prior resection, CTLA-4 ICI exposure, and combination ICI exposure had significantly higher odds for developing a neuro-irAE (p <0.05), but these findings were not statistically significant in the multivariable models. Those with a neuro-irAE had greater survival at 3 years compared to those without a neuro-irAE (69% vs 55%, p=0.004), but after adjusting for patient and cancer characteristics, this effect was no longer statistically significant. Relapse rate of pre-existing neurological condition after exposure to ICI was 15.4% (2/13).

Conclusions Neuro-irAEs are rare and are not associated with an increase in mortality. Potential predictors for the development of neuro irAEs are younger age, melanoma, prior chemotherapy and resection, CTLA-4, or combination ICI exposure. Relapse of a pre-existing neurological condition was uncommon.

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 $500-$4,999 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.

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