"Revolutionary" Cancer Drugs May Have Severe And Deadly Neurological Effects

LOS ANGELES — Checkpoint inhibitors, a novel class of agents promising in the treatment of a wide range of cancers, have been tied to serious neurologic, immune-related adverse events, new research shows.

Checkpoint inhibitors are used to treat melanoma, non-small cell lung cancer, kidney cancer, bladder cancer, and head and neck cancers,
among others. Their neurotoxic effects can be severe, even fatal, warranting increased vigilance and rapid treatment when they are administered, researchers caution.

"I'm a neuromuscular specialist but I have a niche in cancer and chemotherapy. Over the last year and a half I've had eight cases with really rapidly progressive neurotoxicity," study investigator Kelsey Juster-Switlyk, MD, assistant professor in the Division of Neuromuscular Medicine, Department of Neurology, University of Utah Medical Center in Salt Lake City, told Medscape Medical News.

"The neurologic immune-related adverse events are a lot more severe, refractory, and prolonged compared to the non-neurologic," she added during a poster presentation here at the American Academy of Neurology (AAN) 2018 Annual Meeting.

20% Mortality Rate
One patient treated with the checkpoint inhibitor pembrolizumab (Keytruda, Merck) developed autoimmune myositis and myasthenia gravis. Electromyography and muscle biopsy confirmed the diagnoses. In this case, the patient died despite treatment with high-dose corticosteroids, Juster-Switlyk noted.

"The key case I wrote up, the fatal case of myositis, was tragic," she said.

Juster-Switlyk noted that the literature does not offer any consensus on how to reverse these adverse events."

"There are no prospective studies on how to ... Continue Reading