医学
多发性单神经炎
内科学
胃肠病学
无容量
周围神经病变
慢性炎症性脱髓鞘性多发性神经病
肿瘤科
癌症
免疫学
免疫疗法
糖尿病
抗体
内分泌学
疾病
血管炎
作者
Divyanshu Dubey,William S. David,Anthony A. Amato,Kerry L. Reynolds,Nathan F. Clement,Donald F. Chute,Justine V. Cohen,Donald P. Lawrence,Meghan J. Mooradian,Ryan J. Sullivan,Amanda Guidon
出处
期刊:Neurology
[Ovid Technologies (Wolters Kluwer)]
日期:2019-09-10
卷期号:93 (11)
被引量:113
标识
DOI:10.1212/wnl.0000000000008091
摘要
Objective
To describe the spectrum, clinical course, and management of neuropathies associated with immune checkpoint inhibitors (ICIs). Methods
Patients with ICI-related neuropathy (irNeuropathy) were identified and their clinical characteristics compared to neuropathy attributed to cytotoxic agents. Results
We identified 19 patients with irNeuropathies. ICIs included anti-programmed death–1 (PD1), 9; anti-cytotoxic T-lymphocyte-associated antigen-4 (CTLA4), 2; and combination of anti-CTLA4 and anti-PD1, 8. Median number of ICI doses prior to neuropathy onset was 4. Rate of neuropathies following ICI therapy was 0.7%. Underlying malignancies included melanoma (n = 15), lung adenocarcinoma (n = 3), and cholangiocarcinoma (n = 1). Neuropathy phenotypes were cranial neuropathies with or without meningitis (n = 7), nonlength-dependent polyradiculoneuropathies with and without cranial nerve involvement (n = 6), small-fiber/autonomic neuropathy (n = 2), ANCA-associated mononeuritis multiplex (n = 1), sensory neuronopathy (n = 1), length-dependent sensorimotor axonal polyneuropathy (n = 1), and neuralgic amyotrophy (n = 1). Immune-related adverse events involving other organ systems were common (58%). Corticosteroid use for management of neuropathy was associated with improvement in median modified Rankin Scale score (1 vs 0, p = 0.001) and Inflammatory Neuropathy Cause and Treatment Disability score (2 vs 0.5, p = 0.012) (Class IV). Significantly higher proportion of irNeuropathies had acute or subacute and nonlength-dependent presentations (p < 0.001) and rate of hospitalization for irNeuropathy was also higher (p = 0.002) compared to toxic neuropathy from chemotherapy. Conclusion
Neuropathy is a rare complication of ICIs that often responds to immunosuppression. Recognition of its wide phenotypic spectrum and distinct clinical characteristics and prompt management with corticosteroids may lead to favorable outcomes.
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