aInserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM bAP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin cOncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments, Hôpitaux Universitaires Pitié-Salpetrière-Charles Foix et Hôpital d'Instruction des Armées Percy, Paris, France dDepartment of Oncologic Pathology, Dana-Farber/Brigham and Women's Cancer Center eDepartment of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA fService de neurologie, Hôpital d'Instruction des Armées Percy, Service de Santé des Armées, Clamart, France gUMR MD4 8257 CNRS, Université Paris Descartes, SSA, Paris, France, Ecole du Val-de-Grâce, Service de santé des armées, Paris, France.
Curr Opin Neurol. 2017 Dec;30(6):659-668. doi: 10.1097/WCO.0000000000000503.
Immune-checkpoint inhibitors (ICIs) constitute a novel class of agents recently approved to treat a number of human malignancies. Due to their immunomodulatory mechanism of action, ICIs can generate a wide range of immune-related adverse events (irAEs) of which neurological toxicities are of special interest because of their potential severity. The objective of this review is to examine the recent literature describing neurological irAEs and discuss their optimal management.
As opposed to irAEs involving other organs, neurological complications of ICIs are uncommon. These complications encompass various toxicities of the central and peripheral nervous systems, including myositis, myasthenia gravis, demyelinating polyradiculoneuropathy, meningitis and encephalitis. Neurologic irAEs are often responsive to corticosteroids and other immune-modulating treatments (e.g. plasmapheresis, intravenous immunoglobulin), which have been used in patients presenting with severe neurologic irAEs or irAEs unresponsive to corticosteroids. Data from literature indicate that early treatment is critical for reducing the morbidity associated with neurologic irAEs.
ICI-associated irAEs constitute a new group of neurologic complications of systemic anticancer therapies. Although potentially severe, these rare neurologic toxicities are often responsive to immune-modulating therapies. Early recognition and treatment is crucial for timely improvement of functional outcome and requires a multidisciplinary approach.
免疫检查点抑制剂（ICI）是一类新型药物，最近已被批准用于治疗多种人类恶性肿瘤。由于其免疫调节作用机制，ICI 可引发广泛的免疫相关不良事件（irAE），其中神经系统毒性因其潜在的严重性而备受关注。本文旨在查阅描述神经 irAE 的最新文献，并讨论其最佳管理方法。
与涉及其他器官的 irAE 不同，ICI 引起的神经系统并发症并不常见。这些并发症包括中枢和周围神经系统的各种毒性，包括肌炎、重症肌无力、脱髓鞘性多神经根神经病、脑膜炎和脑炎。神经 irAE 通常对皮质类固醇和其他免疫调节治疗（如血浆置换、静脉注射免疫球蛋白）有反应，这些治疗已用于出现严重神经 irAE 或皮质类固醇治疗无效的患者。文献数据表明，早期治疗对于降低与神经 irAE 相关的发病率至关重要。
ICI 相关的 irAE 是全身性抗癌治疗的一组新的神经系统并发症。虽然这些罕见的神经系统毒性可能很严重，但通常对免疫调节治疗有反应。早期识别和治疗对于及时改善功能结局至关重要，需要多学科的方法。
