Detect it so you can treat it: A case series and proposed checklist to detect neurotoxicity in checkpoint therapy
Saskia Bolz1, Thivyah Ramakrishnan1, Michael Fleischer1
1Department of Neurology, Essen University Hospital, Hufelandstrasse 55, 45147 Essen, Germany.
Background:
Checkpoint inhibitors show impressive and durable responses in various cancer types and provide new avenues for cancer immunotherapy. However, these drugs have a variety of adverse events. Common autoimmune-related adverse effects include fatigue, hepatitis, skin rash, endocrine deficiencies, and colitis. Neurotoxicity has been reported, but its incidence and course remain unclear.
Methods:
To illustrate the broad spectrum of neurotoxicity, we exemplarily report the neurological adverse events of five patients with melanoma and one patient with differentiated thyroid cancer who received checkpoint inhibitors at Essen University Hospital (Essen, Germany).
Results:
After treatment with ipilimumab, nivolumab or pembrolizumab, neurotoxic effects included hypophysitis-associated neck pain and headache, Guillain-Barré syndrome, transverse myelitis, acute brachial plexus neuritis, and ocular myasthenia gravis.
Conclusions:
Checkpoint inhibitor therapy remains a success story; however, neurological immune-related adverse events may cause severe life-threatening conditions. We propose a guide for the early detection of neurological adverse events during routine clinical treatment to prevent more severe courses of checkpoint inhibitor-induced neurotoxicity.
Insights
Checkpoint inhibitors offer cancer immunotherapy benefits but can cause neurotoxicity. Early detection of neurological side effects is crucial to prevent severe outcomes.
Area of Science:
- Oncology
- Immunology
- Neurology
Background:
- Checkpoint inhibitors are effective cancer immunotherapies with durable responses.
- Adverse events are common, including autoimmune effects like fatigue and colitis.
- Neurotoxicity is an emerging concern with unclear incidence and progression.
Purpose of the Study:
- To illustrate the spectrum of neurotoxicity associated with checkpoint inhibitors.
- To highlight the importance of recognizing neurological adverse events.
Main Methods:
- Case series reporting neurological adverse events in six patients.
- Patients received ipilimumab, nivolumab, or pembrolizumab for melanoma or differentiated thyroid cancer.
- Data collected from Essen University Hospital, Germany.
Main Results:
- Reported neurotoxic effects included hypophysitis, Guillain-Barré syndrome, transverse myelitis, brachial plexus neuritis, and ocular myasthenia gravis.
- These events occurred after treatment with ipilimumab, nivolumab, or pembrolizumab.
- Neurological immune-related adverse events can be severe and life-threatening.
Conclusions:
- Checkpoint inhibitor therapy is a significant advancement in cancer treatment.
- Neurological immune-related adverse events necessitate careful monitoring.
- A guide for early detection is proposed to prevent severe neurotoxicity.
