Neurotoxicities from Cancer Immunotherapies

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Neuro-oncology".

Deadline for manuscript submissions: closed (30 June 2024) | Viewed by 654

Special Issue Editor


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Guest Editor
1. Neurology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
2. Università Vita-Salute San Raffaele, 20132 Milan, Italy
Interests: brain tumors; paraneoplastic neurological syndromes; autoimmune encephalitis

Special Issue Information

Dear Colleagues,

As you may know, the recent advent of cancer immunotherapy has revolutionized the prognosis of some advanced and refractory cancers, including melanoma and B-cell lymphomas. Regardless of their spectacular therapeutic results, cancer immunotherapies have been associated with a wide range of immune-related neurological complications, ranging from CNS dysfunction to neuromuscular disorders and myositis. Although neurologists, especially at academic cancer centers, have been learning how to diagnose and manage immune-related neurological adverse events, little is still known about rare clinical phenotypes and late-onset toxicities. The prediction and prevention of neurological toxicities is still in its infancy due to the lack of solid biomarkers, and the inadequate characterization of their pathophysiology hampers the implementation of individualized treatment approaches. Optimal treatment strategies in the case of corticosteroid resistance, as well as treatment duration, long-term prognosis and risk of relapse have not been clearly defined. This Special Issue invites original research articles and reviews addressing new clinical phenotypes, identifying novel biomarkers or offering insights on pathophysiology and personalized treatment strategies for immune-related neurological adverse events from cancer immunotherapies, including immune checkpoint inhibitors, CAR-T cells, drug-conjugated and bispecific antibodies. We welcome all contributions shedding light on this exciting area of research straddling between neuro-oncology and neuro-immunology.

Dr. Giulia Berzero
Guest Editor

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Keywords

  • cancer immunotherapy
  • neurological toxicities
  • immune checkpoint inhibitors
  • CAR-T cells and bispecific antibodies
  • cytokine release syndrome
  • biomarkers
  • personalized treatment

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Published Papers (1 paper)

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Review

27 pages, 2249 KiB  
Review
Unravelling the Acute, Chronic and Steroid-Refractory Management of High-Grade Neurological Immune-Related Adverse Events: A Call to Action
by Antonio Malvaso, Pierpaolo Giglio, Luca Diamanti, Matteo Gastaldi, Elisa Vegezzi, Andrea Pace, Paola Bini and Enrico Marchioni
Brain Sci. 2024, 14(8), 764; https://doi.org/10.3390/brainsci14080764 - 29 Jul 2024
Viewed by 384
Abstract
Rare side effects of immune-checkpoint inhibitors (ICIs) are known as neurological immune-related adverse events (n-irAEs). Typically, n-irAEs affect the peripheral nervous system, primarily presenting as myositis, polyradiculoneuropathy, or cranial neuropathy. Less commonly, they impact the central nervous system, resulting in encephalitis, meningitis, or [...] Read more.
Rare side effects of immune-checkpoint inhibitors (ICIs) are known as neurological immune-related adverse events (n-irAEs). Typically, n-irAEs affect the peripheral nervous system, primarily presenting as myositis, polyradiculoneuropathy, or cranial neuropathy. Less commonly, they impact the central nervous system, resulting in encephalitis, meningitis, or myelitis. High-grade n-irAEs managing and recognizing remains challenging, considering the risk of mortality and long-term disability. To date, strong scientific data are lacking to support the management of high-grade clinical forms. We performed a systematic literature search, selecting all articles describing high-grade steroid-resistance n-irAEs. and we reported them in a practical review. Specifically, current recommendations advise stopping ICI use and beginning corticosteroid treatment. Our findings highlighted that in steroid-resistant n-irAEs, it should be recommended to quickly escalate to plasma exchange (PLEX) and/or intravenously immunoglobulins (IVIg), usually in association with other immunosuppressants. Furthermore, newer evidence supports the use of drugs that may specifically block inflammation without reducing the anti-tumour effect of ICIs. In this practical review, we provide new evidence regarding the therapeutic approach of high-grade n-irAEs, particularly in steroid-resistant cases. We would also stress the importance of informing the scientific community of the discrepancy between current guidelines and clinical evidence in these rare forms of pathology. Full article
(This article belongs to the Special Issue Neurotoxicities from Cancer Immunotherapies)
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