PDF(Pubmed)
Abstract：
The increasing use of immune checkpoint inhibitors (ICI) in cancer therapy has brought attention to their associated neurotoxicities, termed neurological immune-related adverse events (n-irAEs). Despite their relatively rare incidence, n-irAEs pose a significant risk, potentially leading to severe, long-lasting disabilities or even fatal outcomes. This narrative review aims to provide a comprehensive overview of n-irAEs, focusing on their recognition and management. The review addresses a spectrum of n-irAEs, encompassing myositis, myasthenia gravis, various neuropathies, and central nervous system complications, such as encephalitis, meningitis, and demyelinating diseases. The key features of n-irAEs are emphasized in this review, including their early onset after initiation of ICIs, potential association with non-neurological irAEs and/or concurrent oncological response, the significance of ruling out other etiologies, and the expected improvement upon discontinuation of ICIs and/or immunosuppression. Furthermore, this review delves into considerations for ICI re-challenge and the intricate nature of n-irAEs within the context of pre-existing autoimmune and paraneoplastic syndromes. It underscores the importance of a multidisciplinary approach to diagnosis and treatment, highlighting the pivotal role of severity grading in guiding treatment decisions.
摘要：
免疫检查点抑制剂（ICI）在癌症治疗中的使用越来越多，引起了人们对其相关神经毒性的关注。称为神经免疫相关不良事件（n-irAEs）。尽管它们的发病率相对罕见，n-irAE构成重大风险，可能导致严重的，长期残疾甚至致命的结果。这篇叙述性综述旨在提供对n-IRAE的全面概述，专注于他们的认可和管理。这篇评论讨论了一系列n-irAE，包括肌炎，重症肌无力,各种神经病,中枢神经系统并发症,比如脑炎，脑膜炎,和脱髓鞘疾病。在这篇综述中强调了n-irAE的关键特征，包括它们在开始ICIs后的早期发作，与非神经系统ERS和/或并发肿瘤反应的潜在关联，排除其他病因的重要性，以及停用ICIs和/或免疫抑制后的预期改善。此外，这篇综述探讨了在预先存在的自身免疫综合征和副肿瘤综合征的背景下，ICI再攻击的考虑因素以及n-irAE的复杂性。它强调了多学科诊断和治疗方法的重要性，强调严重程度分级在指导治疗决策中的关键作用。
