Eur J Neurol. 2023 Jun 23. doi: 10.1111/ene.15942. Online ahead of print.
ABSTRACT
BACKGROUND: Little is known about risk factors for developing neurological immunological adverse events (neuro-irAEs) from immune check point inhibitors (ICI). We report the incidence, predictors for development, impact on mortality of neuro-irAEs, and impact of ICI on pre-existing neurological conditions in a large clinical cohort.
METHODS: Patients who received ICI between January 2011 and December 2018 were identified from a tertiary cancer center registry. Descriptive statistics were used to summarize patient, cancer, and treatment data. Odds ratios from univariable and multivariable logistic regression models were calculated to identify potential predictors for developing a neuro-irAE. Impact of neuro-irAE on overall survival was estimated by Kaplan-Meier and Cox proportional-hazard models.
RESULTS: Overall frequency of neurological irAEs was 2.3%. Peripheral nervous system complications were most frequent (53.6%). Melanoma, younger age, prior chemotherapy, prior resection, CTLA-4 ICI exposure, and combination PD-1 and CTLA-4 ICI exposure had significantly higher odds for developing a neuro-irAE (p <0.05) on univariate but not multivariate models. Those with a neuro-irAE were less likely to die at 3 years compared to those without a neuro-irAE (69% vs 55%, p=0.004) in univariate but not multivariate model. Flare of pre-existing neurological condition after exposure to ICI was present (15.4%, 2 of 13 patients) but manageable. One patient was rechallenged with ICI without recurrent flare.
CONCLUSIONS: Neuro-irAEs are not associated with increase in overall mortality. Potential predictors for the development of neuro irAEs are younger age, melanoma, prior chemotherapy and resection, CTLA-4, or combination ICI exposure.
PMID:37350150 | DOI:10.1111/ene.15942
