Clinical Course of Neurologic Adverse Events Associated With Immune Checkpoint Inhibitors: Focus on Chronic...

Area of Science:

• Neurology
• Immunology
• Oncology

Background:

• Neurologic immune-related adverse events (n-irAEs) are a known complication of immune checkpoint inhibitors (ICIs).
• The long-term clinical course and risk of chronicity for n-irAEs remain poorly understood.
• This study addresses the need for characterizing n-irAEs and their chronic sequelae.

Purpose of the Study:

• To characterize the clinical course of n-irAEs.
• To assess the prevalence and nature of chronic n-irAEs.
• To evaluate the outcomes associated with different n-irAE courses.

Main Methods:

• Nationwide, multicenter, retrospective study of patients with n-irAEs at 7 Italian hospitals.
• Classification of n-irAEs into fulminant, monophasic, or chronic based on clinical course.
• Subdivision of chronic n-irAEs into active and inactive categories based on inflammation markers.

Main Results:

• Sixty-six patients (median age 69) were included, with most n-irAEs affecting the peripheral nervous system.
• 18% of patients experienced a fulminant course, with higher risk if concurrent myocarditis was present.
• Of non-fulminant cases, 57% developed chronic n-irAEs, with over half of these remaining active; chronic n-irAEs were associated with severe disability, shorter survival, and higher mortality.

Conclusions:

• Over half of surviving patients develop chronic n-irAEs after ICI treatment.
• Chronic n-irAEs are associated with significant neurologic disability and increased mortality, often driven by underlying cancer progression.
• Further research is crucial for understanding and managing chronic n-irAEs effectively.