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Multiple sclerosis outcomes after cancer immunotherapy.

Catherine R Garcia1, Rani Jayswal1, Val Adams2,1

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Clinical & Translational Oncology : Official Publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico
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PubMed
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Immune checkpoint inhibitors (ICIs) rarely trigger multiple sclerosis (MS) relapses, which can be severe and fatal. Further research is needed to balance ICI risks against benefits for MS patients.

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Immune checkpoint inhibitorsImmune-related adverse eventsMultiple sclerosis

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Area of Science:

  • Neuro-oncology
  • Immunology
  • Oncology

Background:

  • Neurological immune-related adverse events (irAEs) are rare but serious complications of immune checkpoint inhibitor (ICI) therapy.
  • The impact of ICIs on patients with multiple sclerosis (MS), an immune-mediated neurological condition, remains largely unknown.

Observation:

  • A review of the FDA FAERS database and literature identified 14 cases of MS relapse post-ICI treatment.
  • The median age of presentation was 52 years, with a median time to symptom onset of 29 days.
  • Prior MS history was confirmed in 57.1% of cases, and rapid disease progression, including two deaths, was observed.

Findings:

  • MS relapses following ICI treatment are infrequent but associated with rapid neurological deterioration and mortality.
  • No significant difference in outcomes was observed between CTLA-4 and PD-1/PD-L1 inhibitors.
  • Symptom resolution occurred at a median of 8 weeks.

Implications:

  • The study highlights the potential for severe neurological events in MS patients receiving ICIs.
  • Prospective studies are crucial to evaluate long-term outcomes and risks associated with immunotherapy in this population.
  • Careful consideration is needed to weigh the benefits of ICIs against the risks in patients with MS.