Cheng Ke, Wang Yuqing, Zhou Yuwen, Xia Ruolan, Tang Liansha, Liu Jiyan
Department of Abdominal Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
Clin Med Insights Oncol. 2021 Nov 24;15:11795549211056261. doi: 10.1177/11795549211056261. eCollection 2021.
Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of multiple malignancies, especially in non-small cell lung cancer (NSCLC). With the extensive application of ICIs in clinical practice, clinicians have to manage their toxicities, which are often termed immune-related adverse events (irAEs). Several ICIs, such as nivolumab, pembrolizumab, atezolizumab, and durvalumab, have been approved by the US Food and Drug Administration (FDA) to treat advanced NSCLC, accompanied by a broad spectrum of toxicity reactions. However, ICIs-associated neurological toxicities, regarding polyneuropathy, Bell palsy, encephalopathy, and myasthenia gravis, as uncommon emerging toxicities have not been well recognized, present a challenge for clinicians to improve awareness of supervision, recognition, and management before death from them. Herein, we have summarized the incidence, diagnosis, clinical manifestations, potential mechanisms, treatments, and outcomes of ICIs-related neurotoxicity and optimized the management approach for NSCLC patients. Prompt recognition and proper management are indispensable to reduce the morbidity of these patients with immune-related neurological toxicities.
免疫检查点抑制剂（ICI）彻底改变了多种恶性肿瘤的治疗方式，尤其是在非小细胞肺癌（NSCLC）治疗中。随着ICI在临床实践中的广泛应用，临床医生必须应对其毒性反应，这些毒性反应通常被称为免疫相关不良事件（irAE）。几种ICI，如纳武单抗、帕博利珠单抗、阿特珠单抗和度伐利尤单抗，已被美国食品药品监督管理局（FDA）批准用于治疗晚期NSCLC，但同时也伴随着广泛的毒性反应。然而，ICI相关的神经毒性，如多发性神经病、贝尔麻痹、脑病和重症肌无力，作为罕见的新出现毒性反应尚未得到充分认识，这给临床医生在患者因这些毒性反应死亡前提高监测、识别和管理意识带来了挑战。在此，我们总结了ICI相关神经毒性的发生率、诊断、临床表现、潜在机制、治疗方法及预后，并优化了NSCLC患者的管理方法。及时识别和妥善管理对于降低这些免疫相关神经毒性患者的发病率至关重要。
