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Impact of Immune Checkpoint Inhibitors on the Course of Multiple Sclerosis
Géraldine Androdias1, Louise Noroy1, Dimitri Psimaras1
1From the Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation (G.A., P.N., R.M., S.V.), Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Scléros; Ramsay Santé (G.A., L.G.), Clinique de la Sauvegarde, Lyon; Centre Hospitalier de Valence (L.N.), Service de Neurologie, Valence, France; Sorbonne Université (D.P., C.B.), Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2- Mazarin, Paris, France; OncoNeuroTox Group; Aix Marseille Université (J.P.), APHM, Hôpital de la Timone, Department of Neurology, Marseille; Neurology Department (Y.B., R.D., E.M., T.R.), CRCSEP Paris, Pitié-Salpêtrière Hôpital, APHP; CHU de Caen Normandie (P.B.), Service de Neurologie, Caen; CHU de Toulouse (J.C.), CRC-SEP, Department of Neurology, F-31059 Toulouse Cedex 9; Université Toulouse III, Infinity, INSERM UMR1291 - CNRS UMR5051, F-31024 Toulouse Cedex 3; Polyclinique des Alpes du Sud (Y.D.), Gap, France; Claude Bernard Lyon 1 University (C.F.T.), Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500 and Neuro-Ophthalmology Unit, Hospices Civils de Lyon, Neurological Hospital; Centre Hospitalier de Chambéry (C.G.-J.), Service de Neurologie, Chambéry; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (B.J.), Université Claude Bernard Lyon 1; ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, France; Department of Neurology, Hôpital Lyon Sud, Hospices Civils de Lyon; Service de Neurologie (P.K.), Centre Hospitalier de Luxembourg, L-1210 Luxembourg-Ville, Luxembourg; Department of Neurology (A.K.), Lille Catholic University, Lille Catholic Hospitals, FHU PRECISE; CRCSEP Nice (C.L.-F.), UMR2CA-URRIS, Université Nice Côte d'Azur, Neurologie CHU de Nice Pasteur 2; Department of Medical Oncology (A.M.), Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon 1 (R.M.), Villeurbanne; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; and Centre des Neurosciences de Lyon (S.V.), INSERM 1028 et CNRS UMR5292, Observatoire Français de la Sclérose en Plaques, Lyon, France.
Objectives:
Immune checkpoint inhibitors (ICIs) are increasingly used in cancer treatment. Their mechanism of action raises the question of possible exacerbation of preexisting multiple sclerosis (MS). The aim of our study was to assess the risk of increased MS activity, defined by the occurrence of a relapse and/or a new MRI lesion, after ICI initiation.
Methods:
This French multicentric study collected retrospective and prospective data on patients with MS treated with ICIs after a cancer diagnosis.
Results:
We identified 18 patients with a median age of 48 years. Three of them (17%), all aged 50 years or younger, with a relapsing-remitting course, showed clinical and/or radiologic signs of MS activity 3 to 6 months after ICI initiation. They had stopped disease-modifying treatment (DMT) several months earlier, at the time of cancer diagnosis. Only one had both clinical and MRI activity, with mild severity and complete recovery.
Discussion:
Our study suggests that the overall risk of MS activity under ICI is low and could be mainly driven by DMT discontinuation, as in MS in general. Although larger studies are needed for better risk assessment in younger patients with more active disease, ICI should be considered when needed in patients with MS.
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