Department of Neuro-Oncology, University of Texas MD Anderson, Houston, TX, USA.
Adv Exp Med Biol. 2021;1342:417-429. doi: 10.1007/978-3-030-79308-1_18.
Immunotherapy has revolutionized treatment of cancer over the past two decades. The antitumor effects of immunotherapy approaches are at the expense of growing spectrum of immune-related adverse events (irAEs) due to cross-reactivity between the tumor and normal host tissue. These adverse events can happen in any organ and range from mild to severe and even life-threatening conditions. While neurological irAEs associated with immune checkpoint inhibitors (CPIs) are rare, they pose a significant challenge in management as the clinical phenotypes are heterogenous and frequently necessitate cessation of therapy and systemic immune suppression and lead to transient functional decline. On the other hand, immune effector cell-associated neurotoxicity (ICANS) is common, frequently occurs in conjunction with cytokine release syndrome (CRS), and poses a significant clinical challenge to the development and widespread use of these effective therapies. Early recognition of these neurological syndromes, timely diagnosis, and thoughtful management are key for further clinical development of these effective therapies in cancer patients. Here, we describe clinical phenotypes of CPI-induced neurological complications and ICANS and discuss steps in clinical monitoring, diagnosis, and effective management.
免疫疗法在过去二十年中彻底改变了癌症的治疗方法。由于肿瘤和正常宿主组织之间的交叉反应，免疫疗法的抗肿瘤作用会导致越来越多的免疫相关不良事件（irAEs）。这些不良事件可能发生在任何器官，从轻度到重度，甚至危及生命。虽然与免疫检查点抑制剂（CPIs）相关的神经 irAEs 很少见，但由于其临床表现具有异质性，并且经常需要停止治疗和全身免疫抑制，从而导致短暂的功能下降，因此在管理方面构成了重大挑战。另一方面，免疫效应细胞相关神经毒性（ICANS）很常见，常与细胞因子释放综合征（CRS）同时发生，对这些有效疗法的开发和广泛应用构成了重大临床挑战。早期识别这些神经系统综合征、及时诊断和深思熟虑的管理是这些有效疗法在癌症患者中进一步临床开发的关键。在这里，我们描述了 CPI 引起的神经并发症和 ICANS 的临床表型，并讨论了临床监测、诊断和有效管理的步骤。
