Lopes Sébastien, Pabst Lucile, Bahougne Thibault, Barthélémy Philippe, Guitton Romain, Didier Kevin, Geoffrois Lionnel, Granel-Brocard Florence, Mennecier Bertrand, Mascaux Céline, Kremer Stéphane, Collongues Nicolas
Center for Clinical Investigation, INSERM U1434, Strasbourg University, 1 Avenue Molière, Strasbourg 67098, France; Pharmacy Pharmacology Department, Strasbourg University Hospitals, 1 Place de l'hopital, Strasbourg 67000, France; Regenerative Nanomedicine, INSERM U1260, Strasbourg University, 1 rue Eugène Boeckel, Strasbourg 67000, France.
Pulmonology Department, Strasbourg University Hospitals, 1 Place de l'hopital, Strasbourg 67000, France; Regenerative Nanomedicine, INSERM U1260, Strasbourg University, 1 rue Eugène Boeckel, Strasbourg 67000, France.
Crit Rev Oncol Hematol. 2025 Feb;206:104595. doi: 10.1016/j.critrevonc.2024.104595. Epub 2024 Dec 12.
The ever-increasing use of immune checkpoint inhibitors (ICIs) has significantly improved cancer management, but at the cost of frequent immunologic side effects. Among them, neurologic immune-related adverse events (nirAEs) are less common but pose a challenge to clinicians due to their severity, heterogeneous nature and nonspecific clinical presentation, making diagnosis complex. The prognosis of these nirAEs, especially those related to the central nervous system (CNS), correlates with their rapid recognition and therapeutic management. Indeed, the therapeutic options are sometimes unfamiliar and may be further complicated by the lack of recommendations in the event of failure of a well-managed first-line treatment. Finally, the attribution of ICIs to certain CNS disorders is controversial and may lead to an incorrect decision to discontinue or contraindicate treatment, resulting in an irremediable loss of opportunity for the patient. Therefore, the aim of this review is to present known/suspected CNS nirAEs induced by ICI, their diagnostic approach and management through therapeutic advices for optimal treatment and rechallenge opportunities.
免疫检查点抑制剂（ICI）的使用日益增加，显著改善了癌症治疗，但代价是频繁出现免疫相关副作用。其中，神经系统免疫相关不良事件（nirAE）较为少见，但因其严重性、异质性和非特异性临床表现给临床医生带来挑战，导致诊断复杂。这些nirAE的预后，尤其是与中枢神经系统（CNS）相关的预后，与其能否快速识别和治疗管理相关。事实上，治疗选择有时并不为人熟知，而且在一线治疗管理良好但失败的情况下，由于缺乏相关建议，情况可能会更加复杂。最后，ICI与某些中枢神经系统疾病的关联存在争议，可能导致停药或禁忌治疗的错误决定，给患者造成无法挽回的机会损失。因此，本综述的目的是介绍由ICI诱发的已知/疑似中枢神经系统nirAE、其诊断方法以及通过治疗建议进行的管理，以实现最佳治疗和再次挑战的机会。
