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Neurotoxicity and safety of the rechallenge of immune checkpoint inhibitors: a growing issue in neuro-oncology practice

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Abstract

Neurological, immune-related adverse events (n-irAE) due to immune checkpoint inhibitors (ICI) represent a growing clinical problem in neuro-oncology practice. Although rare, the frequency of n-irAEs will increase as ICI use becomes more common. Central and peripheral nervous systems may be involved, and multiple n-irAEs like myositis, myasthenia gravis, and myocarditis can arise in the same patient. Prompt recognition, initial ICI discontinuation, and treatment with immunosuppressive therapy comprise key aspects of managing these potentially fatal neurological complications. Severe and/or treatment-refractory n-irAEs may occur and require individualized care. In the same vein, a possible reintroduction of ICI after a n-irAE represents an additional challenge in clinical practice. An approach by experienced neurologists involved in highly subspecialized, multidisciplinary care teams is, therefore, of major importance in managing these cases. The present study updates current knowledge regarding presentation forms, diagnostic workflows, outcomes, and general management of n-irAEs. With the aim to guide neurologists in decision-making processes during such scenarios, the study further reviews available data on ICI reintroduction safety in patients with prior n-irAEs.

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Acknowledgements

The authors thank Dr. Marta Simó and Dr. Raul Dominguez for their assistance in the imaging.

Funding

This work was partially supported by a grant from Instituto de Salud Carlos III through the project PI20/00283 (co‐funded by European Regional Development Fund (ERDF)). We also thank CERCA Programme/Generalitat de Catalunya for institutional support.

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  1. Neuro-Oncology Unit, Neurology Department, Hospital Universitari de Bellvitge-Institut Català d Oncologia L’Hospitalet, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, C/Feixa Llarga S/N, 08907, L’Hospitalet, Barcelona, Spain

    M. Villagrán-García & R. Velasco

  2. Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain

    R. Velasco

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Conceptualization, M.V., and R.V.; methodology, M.V., and R.V.; and writing—original draft preparation, M.V; writing—review and editing, R.V., and M.V; supervision, R.V.; project administration, R.V.; funding acquisition, R.V. Both authors have read and agreed to the published version of the manuscript.

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Villagrán-García, M., Velasco, R. Neurotoxicity and safety of the rechallenge of immune checkpoint inhibitors: a growing issue in neuro-oncology practice. Neurol Sci 43, 2339–2361 (2022). https://doi.org/10.1007/s10072-022-05920-4

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