Abstract
INTRODUCTION: Neurological immune-related adverse events are a rare but potentially deadly complication after immune checkpoint inhibitor (ICI) treatment. As multiple sclerosis (MS) is an immune-mediated disease, it is unknown how ICI treatment may affect outcomes.
METHODS: We analyzed the United States Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database for pembrolizumab, atezolizumab, nivolumab, ipilimumab, avelumab, and durvalumab 2 years prior their FDA approval until December 31, 2017, to include all cases with confirmed diagnosis/relapse of MS. We also included cases reported in the literature and a patient from our institution.
RESULTS: We identified 14 cases of MS with median age of presentation of 52 years. Indications for ICI included melanoma in 7 (36.36%) cases, non-small cell lung carcinoma in 2 (18.18%) cases, 1 case (9.09%) each of pleural mesothelioma, renal cell carcinoma, and colorectal cancer, and unreported in 2 (18.18%) cases. History of MS was confirmed in 8 (57.1%) cases. Median time to beginning of symptoms was 29 days with rapid disease progression; two patients died due to their relapse. Median time for symptom resolution was 8 weeks. Outcomes did not vary by comparing CTLA-4 and PD-1/PD-L1 inhibitors.
CONCLUSIONS: Reported MS relapses after ICI are rare, but the adverse events described include rapid neurologic progression and death. Larger and prospective studies are warranted to assess disability and long-term outcomes and outweigh the risks of starting immunotherapy in patients with MS.
Document Type
Review
Publication Date
10-2019
Digital Object Identifier (DOI)
https://doi.org/10.1007/s12094-019-02060-8
Funding Information
Ms. Jayswal was supported by the Biostatistics and Bioinformatics Shared Resource of the University of Kentucky Markey Cancer Center (P30CA177558).
Repository Citation
Garcia, Catherine R.; Jayswal, Rani; Adams, Val R.; Anthony, Lowell B.; and Villano, John L., "Multiple Sclerosis Outcomes after Cancer Immunotherapy" (2019). Markey Cancer Center Faculty Publications. 158.
https://uknowledge.uky.edu/markey_facpub/158
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Notes/Citation Information
Published in Clinical and Translational Oncology, v. 21, issue 10.
© 2019 Springer Nature Switzerland AG.
This is a post-peer-review, pre-copyedit version of an article published in Clinical and Translational Oncology. The final authenticated version is available online at: https://doi.org/10.1007/s12094-019-02060-8