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Evaluation of a self-questionnaire to screen for neurological complications associated with immunological checkpoint
B Lemarchant1, L Mortier2, J Lannoy3
1Unité de neurologie inflammatoire, CRC-SEP, Department of Neurology, CHU de Lille, hôpital Roger-Salengro, Lille, France; Inserm U1172, université de Lille, Lille, France.
Introduction:
Immunological checkpoint inhibitors (ICI) have led to a therapeutic revolution in the management of many cancers and indications are increasing. Neurological complications seem to have a profile quite distinct from that of toxicities related to chemotherapy, although it is possible that some manifestations remain under-reported or misdiagnosed.
Objectives:
(i) To evaluate the value of a self-questionnaire in screening for neurological ICI-related complications. (ii) To investigate whether, apart from the subacute complications described in the literature, neurological complications of more insidious onset might occur.
Method:
Patients followed in dermatology department for skin cancers treated with ICI, completed every infusion a neurological screening auto-questionnaire. Patients were selected for a neurological expertise based on the questionnaire's data.
Results:
In total, 149 patients completed≥1 questionnaire, with a median delay of 174 days from the start of treatment. A total of 229 questionnaires were completed between July 2019 and December 2019. 38 patients were identified for a neurological consultation. None of these patients had a neurological event attributable to ICI. During the follow-up, only one patient had a neurological event related to ICI, which was not revealed by the questionnaire.
Discussion:
Neurological signs in ICI-treated-skin-cancer context are more often due to tumoral progression. Neurological complications of ICI remain rare and unpredictable. The systematic neurological questionnaire has not been shown to be useful in this context. These results highlight the need to educate patients about possible subacute signs that should lead to contact the treating physicians and the need for a close cooperation between dermatologists/oncologists and neurologists.
Insights
A self-administered questionnaire did not effectively screen for neurological complications in patients receiving immune checkpoint inhibitors (ICI). Neurological side effects from ICI therapy are rare and often misattributed, necessitating physician education and collaboration.
Area of Science:
- Oncology
- Neurology
- Immunotherapy
Background:
- Immune checkpoint inhibitors (ICI) have revolutionized cancer treatment, with increasing applications.
- Neurological complications associated with ICI differ from chemotherapy toxicities, but may be under-reported or misdiagnosed.
Purpose of the Study:
- To assess the utility of a self-questionnaire for screening neurological complications of ICI.
- To explore potential insidious-onset neurological complications beyond known subacute presentations.
Main Methods:
- Patients with skin cancer treated with ICI in a dermatology department completed a neurological screening questionnaire at each infusion.
- Patients with concerning questionnaire results were referred for neurological evaluation.
Main Results:
- 149 patients completed at least one questionnaire; 38 were referred for consultation.
- No referred patients experienced ICI-related neurological events; only one ICI-related event occurred during follow-up and was not detected by the questionnaire.
- The questionnaire proved ineffective in identifying neurological complications.
Conclusions:
- Neurological signs in ICI-treated patients are frequently linked to tumor progression rather than ICI toxicity.
- ICI-induced neurological complications are uncommon and unpredictable.
- Systematic questionnaires are not currently useful for screening; patient education on early signs and interdisciplinary collaboration are crucial.
