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Clinical and Translational Oncology
Published in: Clinical and Translational Oncology 10/2019

01-10-2019 | Multiple Sclerosis | Research Article

Multiple sclerosis outcomes after cancer immunotherapy

Authors: Catherine R. Garcia, Rani Jayswal, Val Adams, Lowell B. Anthony, John L. Villano

Published in: Clinical and Translational Oncology | Issue 10/2019

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Abstract

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.
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Metadata
Title
Multiple sclerosis outcomes after cancer immunotherapy
Authors
Catherine R. Garcia
Rani Jayswal
Val Adams
Lowell B. Anthony
John L. Villano
Publication date
01-10-2019
Publisher
Springer International Publishing
Published in
Clinical and Translational Oncology / Issue 10/2019
Print ISSN: 1699-048X
Electronic ISSN: 1699-3055
DOI
https://doi.org/10.1007/s12094-019-02060-8

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