4 years ago

Pembrolizumab induced encephalopathy: a review of neurological toxicities with immune checkpoint inhibitors.

O'Byrne K, Coward J, McCaffrey E, Feng S, Kalokerinos P, Coucher J
The use of immune checkpoint inhibitor (ICI) therapy in the treatment of solid organ malignancies is becoming increasingly common. This has prompted the recognition of a new class of immune related adverse effects (irAEs) which stem from the upregulation of T cell activity causing autoimmunity. Neurological irAEs are a rare complication of ICIs that can lead to long term morbidity. We report a rare case of encephalopathy following treatment with pembrolizumab, where the patient achieved durable disease response despite discontinuation of therapy. We also review the pathophysiology, incidence, clinical presentation, diagnosis and management of neurotoxicity secondary to ICIs. Treatment requires early administration of high dose corticosteroids, and cessation of ICI therapy is often necessary after Grade 3-4 irAEs. However, early data suggests neurological irAEs correlate with a favourable disease response. Consideration should also be given to the optimal duration of ICI therapy in order to minimise the risk of toxicity and optimise healthcare expenditure.

Publisher URL: https://www.ncbi.nlm.nih.gov/pubmed/28843363

DOI: PubMed:28843363

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