Patterns of Neurological Adverse Events Among a Retrospective Cohort of Patients Receiving Immune Checkpoint Inhibitors

Abstract

Aim:

Neurological adverse events (NAEs) are infrequent immune checkpoint inhibitor (ICI) outcomes poorly characterized in extant research, complicating their clinical management.

Methods:

This study characterized the frequency, severity, patterning and timing of NAEs using a large retrospective registry, including all patients who received at least one dose of an ICI from 2/1/2011–4/7/2022 within our health network.

Results:

Among 3137 patients, there were 54 NAEs (1.72% any grade; 0.8% grade 3–4). Most NAEs were peripheral (57.4%) versus central (42.6%). Melanoma and renal cell carcinoma were significantly associated with NAEs.

Conclusion:

The incidence of NAEs was rare though higher than many prior case estimates; the timing was consistent with other AEs. NAEs frequently occurred in tumor types known to favor brain metastases.

Plain language summary

Immune checkpoint inhibitors are new drugs for cancer. They boost your body’s defenses to fight cancer cells. These drugs can be used alone or with other cancer treatments. Most people are okay with these medicines, but some might have problems in different parts of the body. This can be tricky to figure out. Rarely, there can be issues in the brain or nerves. These side effects are rare, happening in about 2 in every 100 people who use the drugs. They are more common in certain cancers like melanoma and kidney cancer. As doctors learn more about these side effects, they can better predict, treat, and prevent them.

Keywords::

• brain metastasis
• central nervous system
• immune checkpoint inhibitors
• incidence
• melanoma
• neurological adverse events
• peripheral nervous system
• renal cell carcinoma

Author contributions

All authors provided substantial contributions to the conception of the work, facilitated in drafting and revising the content, provided final approval of the version submitted, and agreed to be accountable for all aspects of the work.

Financial disclosure

SN Price is supported by a fellowship from the National Cancer Institute (T32CA 122061). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Competing interests disclosure

The authors have no competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, stock ownership or options and expert testimony.

Writing disclosure

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.

Data sharing statement

Data will be made available per written request to the corresponding author. The data used was pre-existing prior to the study and not generated from a clinical trial.