Immune checkpoint inhibitors (ICIs) are associated with various neurological adverse events (NAEs). We herein explored the incidence and clinical phenotype of immune‐related NAEs in cancer patients. Medical records of ICI‐treated cancer patients were reviewed between the years 2010 and 2018, with an aim to characterize immuno‐related NAEs. A total of 1185 ICIs‐treated patients were identified, 63.7% of which were males and 36.3% were females, with a mean age of 63.4 ± 7.3 years. Twenty‐four from the overall ICIs‐treated patients (2%) developed NAEs. No differences were identified in terms of age, sex, tumor type and class of ICIs between the patients who developed NAEs and those who did not. The median number of cycles of ICI treatment before NAEs onset were 4.5 (1‐10), and the median time was 102 days. Peripheral nervous system (PNS) involvement was present in 14 patients (58.4%) and central nervous system (CNS) involvement in 10 (33.3%), including 2 patients with aseptic meningitis and polyradicular involvement. Amongst PNS complications, there were five (20.8%) with axonal sensory neuropathies, four (16.7%) with Guillain‐Barre‐like syndromes, and four (16.7%) with myositis and/or myasthenic syndromes. The majority of patients with PNS‐related NAEs (n = 11; 78.6%) improved after ICIs discontinuation and treatment with immune‐modulating therapies. The time to neuromuscular toxicities onset was significantly shorter, compared to CNS NAEs (median 70 vs 119 days, P = .037). Immune‐related NAEs mostly present with neuromuscular complications. Discontinuation of ICIs and appropriate treatment should be commenced early throughout the process, in order to maximize a favorable outcome.

中文翻译：

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以神经肌肉事件为重点的免疫检查点抑制剂的神经毒性发生率和特征：临床试验以外的经验。

免疫检查点抑制剂（ICI）与各种神经系统不良事件（NAE）相关。我们在这里探讨了癌症患者中免疫相关NAE的发生率和临床表型。在2010年至2018年期间，对ICI治疗的癌症患者的病历进行了回顾，目的是鉴定免疫相关的NAE。总共鉴定出1185名接受ICI治疗的患者，其中男性占63.7％，女性占36.3％，平均年龄为63.4±7.3岁。在所有接受ICI治疗的患者中，有24名（2％）患上了NAE。在年龄，性别，肿瘤类型和ICI分类方面，未发现NAE的患者与未发现NAE的患者之间没有差异。NAE发作前ICI治疗的中位周期数为4.5（1-10），中位时间为102天。周围神经系统（PNS）受累的有14例（58.4％），中枢神经系统（CNS）受累的有10例（33.3％），包括2例无菌性脑膜炎和多发性神经受累。在PNS并发症中，有五种（20.8％）的轴突感觉神经病，四种（16.7％）的格林-巴利样综合征和四例（16.7％）的肌炎和/或肌无力综合征。ICI停用和免疫调节治疗后，大多数PNS相关NAE患者（n = 11； 78.6％）得到改善。与CNS NAE相比，神经肌肉毒性发作的时间显着缩短（中位数为70天比119天，在PNS并发症中，有五种（20.8％）的轴突感觉神经病，四种（16.7％）的格林-巴利样综合征和四例（16.7％）的肌炎和/或肌无力综合征。ICI停用和免疫调节治疗后，大多数PNS相关NAE患者（n = 11； 78.6％）得到改善。与CNS NAE相比，神经肌肉毒性发作的时间显着缩短（中位数为70天比119天，在PNS并发症中，有五种（20.8％）的轴突感觉神经病，四种（16.7％）的格林-巴利样综合征和四例（16.7％）的肌炎和/或肌无力综合征。ICI停用和免疫调节治疗后，大多数PNS相关NAE患者（n = 11； 78.6％）得到改善。与CNS NAE相比，神经肌肉毒性发作的时间显着缩短（中位数为70天比119天，P = .037）。免疫相关的NAE大多伴有神经肌肉并发症。在整个过程中，应尽早停止ICIs治疗并采取适当的治疗措施，以最大程度地提高治疗效果。