Journal
JOURNAL OF THORACIC ONCOLOGY
Volume 12, Issue 11, Pages 1626-1635Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jtho.2017.08.007
Keywords
Immunotherapy; Pembrolizumab; Immune related adverse event; Encephalopathy; Non-small cell lung cancer
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Funding
- Roche
- Pfizer
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The use of immune checkpoint inhibitor (ICI) therapy in the treatment of solid organ malignancies is becoming increasingly common. This has prompted the recognition of a new class of immune-related adverse effects (irAEs) stemming from the upregulation of T-cell activity causing autoimmunity. Neurological irAEs are a rare complication of ICIs that can lead to long-term morbidity. We report a rare case of encephalopathy after treatment with pembrolizumab, to which the patient achieved durable disease response despite discontinuation of therapy. We also review the pathophysiology, incidence, clinical presentation, diagnosis, and management of neurotoxicity secondary to ICIs. Treatment requires early administration of high-dose corticosteroids, and cessation of ICI therapy is often necessary after grade 3 or 4 irAEs. However, early data suggest that neurological irAEs correlate with a favorable disease response. Consideration should also be given to the optimal duration of ICI therapy to minimize the risk of toxicity and optimize health care expenditure. (C) 2017 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.
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