Multiple sclerosis outcomes after cancer immunotherapy

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

Research output: Contribution to journalArticlepeer-review

73 Scopus citations

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.

Original languageEnglish
Pages (from-to)1336-1342
Number of pages7
JournalClinical and Translational Oncology
Volume21
Issue number10
DOIs
StatePublished - Oct 1 2019

Bibliographical note

Publisher Copyright:
© 2019, Federación de Sociedades Españolas de Oncología (FESEO).

Keywords

  • Immune checkpoint inhibitors
  • Immune-related adverse events
  • Multiple sclerosis

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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