- •Immunotherapy has emerged as novel treatment option in cancer patients.
- •The peripheral and central nervous system can be affected by immunotherapy-related side effects.
- •Close monitoring is key for early recognition of immunotherapy-related neurological complications.
- •Adequate therapeutic measures are essential to avoid residual neurological deficits.
Immune checkpoint inhibitors
Background and mode of action
Complications associated with the use of immune checkpoint inhibitors
|Clinical features||Incidence||Differential diagnosis||Diagnostic work-up||Management|
|Peripheral nervous system|
|Polyradiculopathies, neuropathies||ICI: Overall ~ 1.3%; GBS-like syndrome: 0.1–0.2% |
|Myasthenic syndromes||ICI: 0.12–1.16% |
|Myopathies||ICI: 0.58–1.67% |
|Central nervous system|
|Aseptical meningitis||ICI: 0.36%|
|Cytokine release syndrome (CRS)||blinatumomab: 11–14.2% (≥grade III: 0.8–5%); CAR-T cells: 18–100% (≥grade III: 8–46%)|
|Immune effector cell-associated neurotoxicity syndrome (ICANS)||CAR-T cells: 21–64% (≥grade III: 12–31%)|
Diagnostic work-up and differential diagnosis
Immune checkpoint-inhibitor-associated complications involving the peripheral nervous system
Polyradiculopathies and neuropathies
Immune checkpoint inhibitor-associated complications involving the central nervous system
Other complications in the CNS
Immune checkpoint inhibitors in the context of brain tumors
Background and mode of action
Side effects and complications
Adoptive T cell therapy
Background on CAR T cells
Side effects associated with the use of CAR T cells
CAR T cell-associated neurotoxicity
- Parker K.R.
- Migliorini D.
- Perkey E.
- Yost K.E.
- Bhaduri A.
- Bagga P.
- Haris M.
- Wilson N.E.
- Liu F.
- Gabunia K.
- Scholler J.
- Montine T.J.
- Bhoj V.G.
- Reddy R.
- Mohan S.
- Maillard I.
- Kriegstein A.R.
- June C.H.
- Chang H.Y.
- Posey Jr, A.D.
- Satpathy A.T.
Conclusion and outlook
Declaration of Competing Interest
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