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Natural Course of Neurotoxicity after Immune Checkpoint Inhibitor (ICI) Exposure

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Diagnosis, Management and Emerging Strategies for Chemotherapy-Induced Neuropathy

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Abstract

The blockade of immune checkpoint inhibitors (ICIs) with monoclonal antibodies has revolutionized the therapeutic management of several cancer types as these treatments have achieved higher objective response rates and prolonged overall survival. However, targeting of CTLA-4 and PD-1/PD-L1 dysregulates the homeostasis of immune system, thereby increasing the relative risk of systemic immune-related overactivation and immune-related adverse events (irAEs).

Neurological irAEs (NirAEs) are relatively rare but potentially severe and life-threatening. The clinical phenotype of NirAEs greatly varies to involve a wide spectrum of neurological manifestations, although neuromuscular involvement, in the form of myositis, myasthenia gravis, and demyelinating polyradiculoneuropathy, is more frequently disclosed than central nervous system involvement clinically encountered as meningoencephalitis, encephalitis, vasculitis, myelitis, CNS demyelination, neuro-opthalmological events, and cranial neuropathies. Early NirAEs diagnosis, prompt ICIs discontinuation, and induction treatment with immune-modulating therapies, e.g., corticosteroids, IVIG, plasma exchange, and immune suppressants, are factors of paramount importance to optimize clinical outcomes.

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Authors and Affiliations

  1. “Saint Andrew’s” State General Hospital of Patras, Patras, Greece

    Andreas A. Argyriou

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  1. Andreas A. Argyriou
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  1. Yale University School of Medicine, New Haven, CT, USA

    Maryam Lustberg

  2. Mayo Clinic, Rochester, MN, USA

    Charles Loprinzi

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Argyriou, A.A. (2021). Natural Course of Neurotoxicity after Immune Checkpoint Inhibitor (ICI) Exposure. In: Lustberg, M., Loprinzi, C. (eds) Diagnosis, Management and Emerging Strategies for Chemotherapy-Induced Neuropathy. Springer, Cham. https://doi.org/10.1007/978-3-030-78663-2_10

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