Title : Immune checkpoint inhibitor-related cns vasculitis – report of four cases and excerpt from a systematic review
Abstract:
Immune checkpoint inhibitors (ICIs) have emerged as a pivotal class of immunotherapy in the treatment of various cancers. These therapies, while highly effective, can also lead to a spectrum of immune-related adverse events (irAEs), one of which is vasculitis affecting the central nervous system (CNS), termed nirVasculitis. This systematic review aims to delineate the clinical and laboratory characteristics of nirVasculitis associated with ICIs.
Methods: Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, two independent researchers conducted comprehensive searches in PubMed and Embase databases to identify cases of CNS nirVasculitis. Additionally, four cases from our department were included. Patients were classified based on diagnostic certainty into definite, probable, or possible nirVasculitis categories. The study's results are discussed, highlighting detailed case presentations with a particular focus on MRI scans and vessel wall imaging.
Conclusions: NirVasculitis is a rare but potentially underreported and severe condition linked to ICI therapy. Prompt recognition of the condition is crucial to initiate immunosuppressive treatment, which can significantly impact patient outcomes. This review underscores the necessity for heightened awareness and vigilance among clinicians to identify and manage this serious adverse event promptly. This study highlights the importance of recognizing the signs and symptoms of nirVasculitis in patients undergoing ICI therapy, the need for thorough diagnostic evaluation, and the critical role of timely intervention with immunosuppressive treatment to improve patient prognosis.
Audience Take Away Notes:
- The audience will be able to use the findings from this systematic review and cases to better recognize and manage immune-related adverse events (irAEs) associated with immune checkpoint inhibitors (ICIs), specifically central nervous system vasculitis (nirVasculitis). By understanding the clinical and laboratory features of nirVasculitis, healthcare providers can improve diagnostic accuracy and initiate timely and appropriate treatment.
- This research will aid oncologists, neurologists, and other healthcare professionals in their clinical practice by:
- Enhancing their ability to identify symptoms indicative of nirVasculitis.
- Informing them of the typical presentation and progression of the condition.
- Guiding them in the use of diagnostic tools such as brain imaging and cerebrospinal fluid analysis.
- Providing evidence-based recommendations for the management of nirVasculitis, including the use of corticosteroids.
- Other faculty members can utilize this research to:
- Expand their investigations into the adverse effects of ICIs and explore potential mechanisms underlying nirVasculitis.
- Conduct further research into preventive strategies and alternative treatments for nirVasculitis.
- List of all other benefits:
- Raising awareness about a rare but serious condition among healthcare providers.
- Highlighting the need for vigilance and regular monitoring of patients on ICIs.
- Providing a comprehensive summary of the current state of knowledge on nirVasculitis, which can be used as a reference for future studies.
- Encouraging multidisciplinary collaboration in managing complex irAEs.
- Contributing to the overall body of knowledge in oncology and neurology, potentially leading to improved patient outcomes and survival rates.
