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Related Experiment Video

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Immune Checkpoint Inhibitor-Induced Cerebral Pseudoprogression: Patterns and Categorization.

Hans Urban1,2,3,4, Eike Steidl2,3,5, Elke Hattingen2,3,4,5

  • 1Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.

Frontiers in Immunology
|January 20, 2022
PubMed
Summary

Immune checkpoint inhibitors (ICIs) can cause cerebral pseudoprogression, a neurological side effect. This study identified three distinct patterns of this condition in patients receiving ICI therapy, highlighting the need for careful diagnosis.

Keywords:
brain metastasescerebral pseudoprogressionimmune checkpoint inhibitors (ICI)immune related adverse events (irAE)immunotherapyneurological complicationneurological side effects

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Area of Science:

  • Neuro-oncology
  • Immunotherapy
  • Radiology

Background:

  • Immune checkpoint inhibitors (ICIs) improve survival in metastatic cancers.
  • Neurological immune-related adverse events (IRAEs) are increasingly observed with ICI use.
  • Cerebral pseudoprogression is a rare but significant IRAE.

Purpose of the Study:

  • To determine the incidence of ICI-induced cerebral pseudoprogression.
  • To classify the imaging patterns of cerebral pseudoprogression.
  • To emphasize the clinical significance of this IRAE.

Main Methods:

  • Retrospective analysis of patients treated with ICIs between 2007-2019.
  • Inclusion of patients with diagnostic quality cerebral MRI (cMRI).
  • Retrospective cMRI analysis using immunotherapy response assessment for neuro-oncology (iRANO) criteria.

Main Results:

  • 12 cases of cerebral pseudoprogression identified in 123 patients (9.75% with sufficient imaging).
  • Most common in lung cancer and melanoma patients; median onset at 5 months.
  • Three distinct patterns observed: contrast-enhancing lesions, T2 lesions, and cerebral vasculitis.

Conclusions:

  • Cerebral pseudoprogression occurs in 3.2% of patients on ICI therapy.
  • The condition presents with three distinct imaging patterns.
  • Neurological symptoms mandate vigilance for ICI-induced cerebral lesions, as they mimic disease progression.