Clinical Neurology Unit, San Paolo University Hospital, Department of Health Sciences and "Aldo Ravelli" Research Center for Experimental Brain Theraputics, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy.
Neurol Sci. 2023 Jan;44(1):137-148. doi: 10.1007/s10072-022-06297-0. Epub 2022 Sep 16.
Immunotherapy is nowadays considered a mainstay of cancer treatment, dramatically affecting the disease-free survival rate in several aggressive malignancies. Unfortunately, cancer immunotherapy can also trigger life-threatening autoimmune neurological complications named "neurological adverse effects" (NAEs). NAEs can affect both the central nervous system (CNS), as in ipilimumab-related aseptic meningitis, and the peripheral nervous system (PNS), as in nivolumab-induced myasthenia gravis.
The incidence of NAEs is highly variable, ranging from 2 to 4% using checkpoint inhibitors to 50% using blinatumomab. Looking at these numbers, it appears clear that neurologists will soon be called more and more frequently to decide upon the best therapeutic strategy for a patient receiving immunotherapy and experiencing a NAE. Most of them can be treated or reverted withholding the offending drug and adding IVIg, plasmapheresis, or steroids to the therapy. Sometimes, however, for oncological reasons, immunotherapy cannot be stopped so the neurologist needs to know what countermeasures have proven most effective. Moreover, patients with a pre-existing autoimmune neurological disease (AID), such as myasthenia gravis or multiple sclerosis, might need immunotherapy during their life, risking a severe worsening of their symptoms. In that setting, the neurologist needs to properly counsel patients about the risk of a therapy-related relapse.
In this article, we describe the most frequently reported NAEs and aim to give neurologists a practical overview on how to deal with them.
免疫疗法如今被认为是癌症治疗的主要方法，极大地提高了几种侵袭性恶性肿瘤的无病生存率。不幸的是，癌症免疫疗法也可能引发危及生命的自身免疫性神经并发症，称为“神经不良反应”（NAE）。NAE 可影响中枢神经系统（CNS），如依匹单抗相关的无菌性脑膜炎，也可影响周围神经系统（PNS），如纳武单抗引起的重症肌无力。
NAE 的发生率差异很大，使用检查点抑制剂的发生率为 2%至 4%，使用blinatumomab 的发生率为 50%。从这些数字可以清楚地看出，神经科医生将越来越频繁地被要求为接受免疫治疗并出现 NAE 的患者决定最佳治疗策略。大多数 NAE 可以通过停药和在治疗中添加 IVIg、血浆置换或类固醇来治疗或逆转。然而，有时出于肿瘤学原因，免疫疗法不能停止，因此神经科医生需要了解哪些对策最有效。此外，患有自身免疫性神经疾病（AID）的患者，如重症肌无力或多发性硬化症，可能在其一生中需要接受免疫治疗，从而使他们的症状严重恶化。在这种情况下，神经科医生需要就治疗相关复发的风险对患者进行适当的咨询。
本文描述了最常报道的 NAE，并旨在为神经科医生提供处理这些不良反应的实用概述。
