Abstract
The emergence of immune-based treatments for cancer has led to a growing field dedicated to understanding and managing iatrogenic immunotoxicities that arise from these agents. Immune-related adverse events (irAEs) can develop as isolated events or as toxicities affecting multiple body systems. In particular, this review details the neurological irAEs from immune checkpoint inhibitors (ICI) and chimeric antigen receptor (CAR) T cell immunotherapies. The recognition and treatment of neurological irAEs has variable success, depending on the severity and nature of the neurological involvement. Understanding the involved mechanisms, predicting those at higher risk for irAEs, and establishing safety parameters for resuming cancer immunotherapies after irAEs are all important fields of ongoing research.
Highlights
Genome-wide single nucleotide polymorphism (SNP) data from patients on immune checkpoint inhibitors (ICI) has the potential to identify variants in the genome correlated with risk of Immunerelated adverse events (irAEs) [35]; a recently published study investigating selected SNPs in patients with irAEs from nivolumab showed no clinical implication in predicting toxicity
Elevated IL-2, granulocyte–macrophage colony-stimulating factor (GM-Cerebrospinal fluid (CSF)), and ferritin are significantly associated with neurologic events of Grade 3 or higher
As treatment of cancer expands to harness the power of the human immune system, the need to understand irAEs and toxicity grows
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Iatrogenic neuroinflammatory diseases are a growing subfield of neuroimmunology and relates to cancer immunotherapy, and to oncology. These differing conditions can at times appear to be clinically and radiographically indistinct from more classical neuroinflammatory diseases, such as multiple sclerosis or myasthenia gravis; they are distinguished by a history of exposure to immunomodulation as well as differences in management relative to sporadic neuroinflammatory disease. This review will cally focusofon neurological irAEs from currently available, FDA-approved cancer immufocus on neurological irAEsTfrom currently available, FDA-approved cancer immunotheranotherapies: ICIs and CAR cell therapy.
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