Neurologic Complications of Cancer Immunotherapy

Area of Science:

• Oncology
• Neurology
• Immunology

Background:

• Cancer immunotherapy, including immune checkpoint inhibitors (ICIs), adoptive T-cell therapies, and T-cell redirecting therapies, has transformed oncologic care.
• The widespread adoption of these treatments has led to an increased incidence of immune-related adverse events (irAEs).
• Neurologic complications represent a significant subset of irAEs, necessitating specialized diagnostic and management strategies.

Purpose of the Study:

• To comprehensively review the clinical spectrum, diagnostic approaches, therapeutic interventions, and prognostic factors of neurologic complications arising from modern immunotherapies.
• To provide a structured clinical framework for managing patients experiencing neurotoxicity associated with immune checkpoint inhibitors, adoptive T-cell therapies, and T-cell redirecting therapies.
• To enhance clinician preparedness in recognizing and treating these potentially severe adverse events, aiming to minimize patient morbidity.

Main Methods:

• Systematic literature review of peer-reviewed publications.
• Analysis of clinical case reports, cohort studies, and clinical trial data focusing on neurotoxicity from immunotherapies.
• Synthesis of current evidence to describe clinical manifestations, diagnostic criteria, treatment options, and outcomes.

Main Results:

• Diverse neurologic syndromes can manifest, including meningitis, encephalitis, myelitis, peripheral neuropathies, and neuromuscular junction disorders.
• Diagnosis relies on a combination of clinical presentation, cerebrospinal fluid analysis, neuroimaging (MRI), and electrophysiologic studies.
• Management typically involves immunotherapy discontinuation, systemic corticosteroids, and potentially other immunomodulatory agents, tailored to the specific neurologic syndrome.

Conclusions:

• Neurologic complications are an important consideration in patients receiving cancer immunotherapy.
• Early recognition, accurate diagnosis, and prompt, appropriate management are crucial for improving patient outcomes and reducing long-term disability.
• A systematic clinical approach is recommended to guide the management of neurotoxicity associated with these potent anti-cancer agents.