Bolz Saskia, Ramakrishnan Thivyah, Fleischer Michael, Livingstone Elisabeth, Stolte Benjamin, Thimm Andreas, Kizina Kathrin, Ugurel Selma, Kleinschnitz Christoph, Glas Martin, Zimmer Lisa, Hagenacker Tim
Department of Neurology, Essen University Hospital, Hufelandstrasse 55, 45147 Essen, Germany.
Department of Dermatology, Essen University Hospital, Hufelandstrasse 55, 45147 Essen, Germany.
eNeurologicalSci. 2021 Feb 1;22:100324. doi: 10.1016/j.ensci.2021.100324. eCollection 2021 Mar.
Checkpoint inhibitors show impressive and durable responses in various cancer types and provide new avenues for cancer immunotherapy. However, these drugs have a variety of adverse events. Common autoimmune-related adverse effects include fatigue, hepatitis, skin rash, endocrine deficiencies, and colitis. Neurotoxicity has been reported, but its incidence and course remain unclear.
To illustrate the broad spectrum of neurotoxicity, we exemplarily report the neurological adverse events of five patients with melanoma and one patient with differentiated thyroid cancer who received checkpoint inhibitors at Essen University Hospital (Essen, Germany).
After treatment with ipilimumab, nivolumab or pembrolizumab, neurotoxic effects included hypophysitis-associated neck pain and headache, Guillain-Barré syndrome, transverse myelitis, acute brachial plexus neuritis, and ocular myasthenia gravis.
Checkpoint inhibitor therapy remains a success story; however, neurological immune-related adverse events may cause severe life-threatening conditions. We propose a guide for the early detection of neurological adverse events during routine clinical treatment to prevent more severe courses of checkpoint inhibitor-induced neurotoxicity.
检查点抑制剂在多种癌症类型中显示出令人印象深刻且持久的疗效，为癌症免疫治疗提供了新途径。然而，这些药物存在多种不良事件。常见的自身免疫相关不良反应包括疲劳、肝炎、皮疹、内分泌缺陷和结肠炎。已有神经毒性的报道，但其发生率和病程仍不清楚。
为说明神经毒性的广泛范围，我们示例性地报告了在德国埃森大学医院接受检查点抑制剂治疗的5例黑色素瘤患者和1例分化型甲状腺癌患者的神经学不良事件。
在用伊匹木单抗、纳武单抗或帕博利珠单抗治疗后，神经毒性效应包括与垂体炎相关的颈部疼痛和头痛、吉兰-巴雷综合征、横贯性脊髓炎、急性臂丛神经炎和眼肌型重症肌无力。
检查点抑制剂疗法仍然是一个成功案例；然而，神经学免疫相关不良事件可能导致严重的危及生命的情况。我们提出了一个在常规临床治疗期间早期发现神经学不良事件的指南，以预防检查点抑制剂诱导的神经毒性出现更严重的病程。
