Neurologic Complications of Cancer and Its Treatment

This article discusses the diagnosis and treatment of cancer-related neurologic complications including (1) diagnosis and management of brain, spinal, and leptomeningeal metastases; (2) toxicities of conventional cytotoxic, biologic, and targeted therapies with a focus on immunotherapies (immune checkpoint inhibitors and chimeric antigen receptor [CAR] T-cell therapy); (3) paraneoplastic syndromes; and (4) acute and long-term sequelae, including seizures, stroke, neuropathy, and long-term effects of young adult and childhood cancer treatment.

Brain metastases can differ genetically from the primary neoplasm, with some responding to systemic rather than local therapies. Increasing use of immune checkpoint inhibitors has increased the incidence of immune-mediated neurologic complications, including paraneoplastic neurologic syndromes. CAR T-cell therapy, initially developed for leukemia and lymphoma, is being applied to an increasing range of cancers and can cause complications such as cytokine release syndrome and immune effector cell-associated neurologic syndrome, for which specific therapeutic protocols are available.

Prompt recognition of direct and indirect neurologic complications of systemic cancers and their evolving treatments is essential to maximize favorable outcomes. Neurologists should be familiar with common and rare neurologic toxicities of conventional chemotherapy, immune checkpoint inhibitors, and CAR T-cell therapy.