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Severe Neurological Toxicity of Immune Checkpoint Inhibitors: Growing Spectrum
Author(s) -
Dubey Divyanshu,
David William S.,
Reynolds Kerry L.,
Chute Donald F.,
Clement Nathan F.,
Cohen Justine V.,
Lawrence Donald P.,
Mooradian Meghan J.,
Sullivan Ryan J.,
Guidon Amanda C.
Publication year - 2020
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.25708
Subject(s) - adverse effect , medicine , immune system , toxicity , broad spectrum , intensive care medicine , immunology , chemistry , combinatorial chemistry
Expanding use of immune‐checkpoint inhibitors (ICIs) underscores the importance of accurate diagnosis and timely management of neurological immune‐related adverse events (irAE‐N). We evaluate the real‐world frequency, phenotypes, co‐occurring immune‐related adverse events (irAEs), and long‐term outcomes of severe, grade III to V irAE‐N at a tertiary care center over 6 years. We analyze how our experience supports published literature and professional society guidelines. We also discuss these data with regard to common clinical scenarios, such as combination therapy, ICI rechallenge and risk of relapse of irAE‐N, and corticosteroid taper, which are not specifically addressed by current guidelines and/or have limited data. Recommendations for management and future irAE‐N reporting are outlined. ANN NEUROL 2020;87:659–669