How we treat neurological toxicity from immune checkpoint inhibitors

Area of Science:

• Neuro-oncology
• Immunology
• Neurology

Background:

• Immune checkpoint inhibitors (ICIs), including anti-cytotoxic T-lymphocyte antigen 4 (CTLA4) and anti-programmed death receptor 1 (anti-PD-1) therapies, are widely used in cancer treatment.
• Neurological adverse events (NAEs) associated with ICIs, especially combination therapies, are increasingly recognized.
• These NAEs present with diverse and often subacute symptoms, affecting various parts of the nervous system.

Purpose of the Study:

• To highlight the increasing incidence and variability of neurological adverse events associated with immune checkpoint inhibition.
• To emphasize the importance of prompt patient education and clinical assessment for suspected neurotoxicity.
• To outline the current management strategies for these adverse events.

Main Methods:

• Review of clinical literature and case reports concerning neurological complications of immune checkpoint inhibitors.
• Analysis of presenting symptoms, diagnostic challenges, and treatment outcomes.
• Emphasis on the role of specialist neurology consultation.

Main Results:

• Neurological adverse events manifest with a wide range of symptoms due to the complexity of the nervous system.
• Combination anti-CTLA4 and anti-PD-1 therapies are associated with a higher risk of neurological toxicities.
• Early recognition and intervention are critical to mitigate potential morbidity and mortality.

Conclusions:

• Immune checkpoint inhibitor-related neurological adverse events require vigilant monitoring and prompt management.
• Corticosteroids form the cornerstone of treatment, alongside other immunomodulatory therapies as indicated.
• Multidisciplinary collaboration, particularly involving neurologists, is essential for optimal patient care and outcomes.