Multiple sclerosis outcomes after cancer immunotherapy
Multiple sclerosis outcomes after cancer immunotherapy
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DOI：
10.1007/s12094-019-02060-8
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发表时间：
2019-10-01
影响因子：
3.4
通讯作者：
Villano, John L.
中科院分区：
文献类型：
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作者：
Garcia, Catherine R.;Jayswal, Rani;Villano, John L.
神经免疫相关不良事件是免疫检查点抑制剂（ICI）治疗后罕见但可能致命的并发症。由于多发性硬化症（MS）是一种免疫介导的疾病，目前尚不清楚ICI治疗如何影响结果。方法我们分析了美国食品药品监督管理局（FDA）不良事件报告系统（FAERS）数据库中pembrolizumab，atezolizumab，nivolumab，ipilimumab，avelumab和durvalumab在FDA批准前2年至2017年12月31日，包括所有确诊/复发MS的病例。结果我们确定了14例MS，中位年龄为52岁。ICI的适应症包括7例（36.36%）黑色素瘤，2例（18.18%）非小细胞肺癌，胸膜间皮瘤、肾细胞癌和结直肠癌各1例（9.09%），2例（18.18%）未报告。8例（57.1%）病例证实有MS病史。至出现症状的中位时间为29天，疾病进展迅速; 2名患者因复发而死亡。症状缓解的中位时间为8周。通过比较CTLA-4和PD-1/PD-L1抑制剂，结果没有变化。结论：ICI后MS复发的报道是罕见的，但所描述的不良事件包括快速的神经系统进展和死亡。需要进行更大规模的前瞻性研究来评估残疾和长期结局，并超过MS患者开始免疫治疗的风险。
Introduction Neurological immune-related adverse events are a rare but potentially deadly complication after immune checkpoint inhibitor (ICI) treatment. As multiple sclerosis (MS) is an immune-mediated disease, it is unknown how ICI treatment may affect outcomes. Methods We analyzed the United States Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database for pembrolizumab, atezolizumab, nivolumab, ipilimumab, avelumab, and durvalumab 2 years prior their FDA approval until December 31, 2017, to include all cases with confirmed diagnosis/relapse of MS. We also included cases reported in the literature and a patient from our institution. Results We identified 14 cases of MS with median age of presentation of 52 years. Indications for ICI included melanoma in 7 (36.36%) cases, non-small cell lung carcinoma in 2 (18.18%) cases, 1 case (9.09%) each of pleural mesothelioma, renal cell carcinoma, and colorectal cancer, and unreported in 2 (18.18%) cases. History of MS was confirmed in 8 (57.1%) cases. Median time to beginning of symptoms was 29 days with rapid disease progression; two patients died due to their relapse. Median time for symptom resolution was 8 weeks. Outcomes did not vary by comparing CTLA-4 and PD-1/PD-L1 inhibitors. Conclusions Reported MS relapses after ICI are rare, but the adverse events described include rapid neurologic progression and death. Larger and prospective studies are warranted to assess disability and long-term outcomes and outweigh the risks of starting immunotherapy in patients with MS.