Severe Neurological Toxicity of Immune Checkpoint Inhibitors: Growing Spectrum |
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| Authors: | Divyanshu Dubey MD William S David MD PhD Kerry L Reynolds MD Donald F Chute BA Nathan F Clement MD Justine V Cohen DO Donald P Lawrence MD Meghan J Mooradian MD Ryan J Sullivan MD Amanda C Guidon MD |
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| Institution: | 1. Department of Neurology, Massachusetts General Hospital, Boston, MA;2. Department of Medicine, Massachusetts General Hospital, Boston, MA;3. Department of Pathology, Massachusetts General Hospital, Boston, MA |
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| Abstract: | Expanding use of immune-checkpoint inhibitors (ICIs) underscores the importance of accurate diagnosis and timely management of neurological immune-related adverse events (irAE-N). We evaluate the real-world frequency, phenotypes, co-occurring immune-related adverse events (irAEs), and long-term outcomes of severe, grade III to V irAE-N at a tertiary care center over 6 years. We analyze how our experience supports published literature and professional society guidelines. We also discuss these data with regard to common clinical scenarios, such as combination therapy, ICI rechallenge and risk of relapse of irAE-N, and corticosteroid taper, which are not specifically addressed by current guidelines and/or have limited data. Recommendations for management and future irAE-N reporting are outlined. ANN NEUROL 2020;87:659–669 |
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