Abstract:The introduction of immune checkpoint inhibitors (ICIs) has dramatically changed the landscape of treatment for a variety of cancers. However, there is increasing recognition of neurotoxicity related to ICI use. In this review, we will discuss the peripheral nervous system neurologic immune related adverse events (PNS-nirAEs) of anti-CTLA4, anti-PD1, and anti-PDL1 ICIs, including nerve, neuromuscular junction, muscle, and overlap syndromes. We will discuss the relevant epidemiology, pathophysiology, clinical syndromes, diagnostic approaches, treatment, and prognosis of PNS-nirAEs. We will discuss the safety and efficacy of ICIs when utilized in patients with pre-existing neurologic autoimmune disorders (NAIDs). Lastly, we will discuss relevant treatment options and when to consider rechallenging with ICI after an initial de novo PNS-nirAE or exacerbation of a pre-existing NAID.
Abstract:Immunotherapies such as chimeric antigen receptor T cell (CAR-T) therapy and immune checkpoint inhibitors have improved cancer survival but are associated with potentially severe neurotoxicities that can impair neurologic function, quality of life, and survival. Despite their growing use, substantial disparities persist in the recognition, diagnosis, and management of cancer therapy-related neurotoxicities, disproportionately affecting underserved populations. In this review, we apply the social-ecological model (SEM) to examine how factors across individual, interpersonal, organizational, community, and policy levels contribute to inequities in neurotoxicology care. We synthesize evidence on barriers to early detection and access to neurologic expertise and highlight emerging strategies to promote equity, including early symptom recognition, improved specialty access, and supportive institutional infrastructure. We also explore the potential of behavioral economics-informed approaches and artificial intelligence-enabled tools, including telemedicine and remote monitoring, as scalable strategies to reduce inequities in neurotoxicity care.
Abstract:Approximately half of the brain subsumes visual function, so neurologic toxicities of immunotherapy medications may frequently manifest with visual symptoms. As the use of immunotherapeutic medicines proliferates for a broader array of indications, neuro-ophthalmologists in clinical practice may increasingly be referred patients with visual symptoms that result. In this review, we discuss the spectrum of neuro-ophthalmic manifestations of immunotherapy toxicity with a broad review of the literature. Both immune checkpoint inhibitors and chimeric antigen receptor T cell therapies are discussed.
