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Cancers 2019, 11(3), 296; https://doi.org/10.3390/cancers11030296

PD-1 Inhibitors-Related Neurological Toxicities in Patients with Non-Small-Cell Lung Cancer: A Literature Review

1
Department of Oncology, Division of Experimental Medicine, IRCCS San Raffaele, Via Olgettina 60, 20132 Milan, Italy
2
Department of Oncology, ASST Fatebenefratelli Sacco, 20121 Milan, Italy
*
Author to whom correspondence should be addressed.
Received: 26 December 2018 / Revised: 23 February 2019 / Accepted: 25 February 2019 / Published: 1 March 2019
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Abstract

The advent of immune checkpoint inhibitors gave rise to a new era in oncology and general medicine. The increasing use of programmed death-1 (PD-1) inhibitors in non-small cell lung cancer and in other malignancies means clinicians have to face up to new challenges in managing immune-related adverse events (irAEs), which often resemble autoimmune diseases. Neurological irAEs represent an emerging toxicity related to immunotherapy, and it is mandatory to know how to monitor, recognize, and manage them, since they can rapidly lead to patient death if untreated. Guidelines for the diagnosis and treatment of these irAEs have been recently published but sharing some of the most unusual clinical cases is crucial, in our opinion, to improve awareness and to optimize the approach for these patients. A literature review on the diagnosis and treatment of immune-related neurotoxicity’s has been conducted starting from the report of four cases of neurological irAEs regarding cases of polyneuropathy, myasthenia gravis, Bell’s palsy, and encephalopathy, all of which occurred in oncological patients receiving PD-1 inhibitors (pembrolizumab and nivolumab) for the treatment of non-oncogene addicted advanced non-small cell lung cancer. The exclusion of other differential diagnoses and the correlation between the suspension of immunotherapy and improvement of symptoms suggest that immunotherapy could be the cause of the neurological disorders reported. View Full-Text
Keywords: immunotherapy; neurotoxicity; polyneuropathy; myasthenia gravis; Bell’s palsy; encephalopathy; nivolumab; pembrolizumab immunotherapy; neurotoxicity; polyneuropathy; myasthenia gravis; Bell’s palsy; encephalopathy; nivolumab; pembrolizumab
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Mirabile, A.; Brioschi, E.; Ducceschi, M.; Piva, S.; Lazzari, C.; Bulotta, A.; Viganò, M.G.; Petrella, G.; Gianni, L.; Gregorc, V. PD-1 Inhibitors-Related Neurological Toxicities in Patients with Non-Small-Cell Lung Cancer: A Literature Review. Cancers 2019, 11, 296.

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