Ntox-15. Patient Perspectives on Lumbar Puncture

Abstract

BACKGROUND:Immune checkpoint blockade has shown significant antitumor responses and is approved for the treatment of multiple cancer types. Immune checkpoint inhibitors (ICI) are associated with a unique set of toxicities termed irAEs. This study seeks to review the incidence and clinical manifestations of patients who developed neuro-toxicity with ICIs. METHODS: An IRB approved retrospective study involved review of charts and institutional databases. We identified patients who developed neurotoxicity while on at least one of the following ICIs: anti-CTLA4, anti-PD1 or anti-PD-L1 over a 6 year period (1/1/2010-5/15/2016). RESULTS: We identified a total of 3,804 patients who were treated with one or more ICI during the period of review. Neuro-toxicity was observed in 99 patients (2.6%) affecting both central and peripheral nervous systems. 35 patients (34.7%) received more than one ICI. Median number of cycles prior to developing toxicity was 3 (1-29). Ten patients had more than 1 neuro-toxicity. The various neurologic phenotypes observed in patients included: Sensory neuropathy (34), encephalopathy (18), headache ( 16), aseptic meningitis (13), Myasthenia Gravis like syndrome ( 6), myopathy (6), autonomic neuropathy (5), aphasia syndromes (3), radiculopathy (2), brachial plexitis (2), mononeuritis multiplex (2), AIDP (1), and PRES (1). 58 patients required hospital admission and 2 required ICU level of care. A diagnosis of neuro-toxicity was based upon the temporal association with ICIs and appropriate workup including but not limited to neurologic consultation, lumbar puncture, and neuro-imaging. Patients were treated with drug holiday, observation, corticosteroids, plasmapheresis and/or IVIG. CONCLUSIONS: As ICI's are being used with increased frequency, treating oncologists should be aware of the varied manifestations of neuro-toxicity in order to ensure appropriate diagnosis, work up and treatment. Prompt treatment may relay a benefit in regards to outcome.