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Neurologic Outcomes in People With Multiple Sclerosis Treated With Immune Checkpoint Inhibitors for Oncologic
Carson M Quinn1, Prashanth Rajarajan1, Alexander J Gill1
1From the Department of Neurology (C.M.Q., P.R., S.E.C., S.B.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (A.J.G., J.C.P.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (H.K., T.E.B., I.K.), NYU Grossman School of Medicine, New York; Department of Neurology (A.B.W., E.A.), University of Colorado School of Medicine, Aurora; Department of Neurology (C.S.d.C., V.B.), Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ; Department of Neurology (J.L., P.C.), Stony Brook University Medical Center, NY; Sidney Kimmel Comprehensive Cancer Center (J.C.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (K.M.G.), Stanford University, CA; Medical Partnership 4 MS+ (MP4MS+) (D.K.), LaBelle, FL.
Immune checkpoint inhibitors (ICIs) rarely caused new multiple sclerosis (MS) activity or neurologic side effects in older cancer patients with MS. These findings suggest ICIs may be safe for older MS patients, but more research is needed for younger individuals.
Area of Science:
- Oncology
- Neurology
- Immunology
Background:
- Immune checkpoint inhibitors (ICIs) are vital cancer treatments but can cause immune-related adverse events (irAEs).
- Patients with pre-existing autoimmune diseases, like multiple sclerosis (MS), may face higher irAE risks or disease exacerbation.
- Limited data exist on ICI safety in MS patients due to trial exclusions.
Purpose of the Study:
- To evaluate the incidence of MS activity and irAEs (neurologic and non-neurologic) in patients with MS receiving ICIs for cancer.
Main Methods:
- A retrospective observational study involving seven academic centers.
- Systematic electronic medical record review for patients diagnosed with MS and treated with ICIs.
- Data abstraction included demographics, MS and cancer history, treatments, and outcomes.
Main Results:
- 66 patients with MS (median age 66) treated with ICIs for various cancers were identified.
- During follow-up, 3% experienced MS relapse/activity, 5% had neurologic irAEs, and 32% had non-neurologic irAEs.
- Cancer remission was observed in 38%, while 53% of patients died.
Conclusions:
- MS activity and neurologic irAEs were infrequent in older MS patients treated with ICIs.
- Preexisting MS may not be a contraindication for ICI use in older cancer patients.
- Further prospective studies are required for younger MS patients and those with active disease.
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