Evaluation and management of acute high-grade immunotherapy-related neurotoxicity
Marcelo Sandoval, MD,
Adriana H. Wechsler, MD,
Zahra Alhajji, MD,
Jayne Viets-Upchurch, MD,
Patricia Brock, MD,
Demis N. Lipe, MD,
Aisha Al-breiki, MD,
Sai-Ching J. Yeung, MD
Affiliations
Marcelo Sandoval, MD
Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Corresponding author. Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030, USA.
Adriana H. Wechsler, MD
Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Zahra Alhajji, MD
Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Jayne Viets-Upchurch, MD
Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Patricia Brock, MD
Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Demis N. Lipe, MD
Department of Medical Services, IQVIA Biotech, Houston, TX, USA
Aisha Al-breiki, MD
Department of Emergency Medicine, Sultan Qaboos University Hospital, Muscat, Oman
Sai-Ching J. Yeung, MD
Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Immune checkpoint inhibitor monoclonal antibodies allow the host's immune system to attack tumors, which has revolutionized cancer care over the last decade. As the use of immune checkpoint inhibitors has expanded, so have autoimmune-like complications known as immune-related adverse events. These include the infrequent but increasingly more common, potentially deadly neurological immune related adverse events. When feeling acutely ill, patients will often seek care not from their oncologist but from their family physician, clinics, emergency, and urgent care sites, or other available providers. Thus, while assessing acutely ill cancer patients who are experiencing neurological symptoms, non-oncologists should be prepared to recognize, diagnose, and treat neurological immune related adverse events in addition to more familiar conditions. This narrative review is designed to update acute care clinicians on current knowledge and to present a symptom-based framework for evaluating and treating neurological immune related adverse events based on the leading immunotoxicity organizations' latest recommendations.
