title: Neurologic complications of immune checkpoint inhibitors.
abstract: In recent years, advances in the understanding of the regulatory mechanisms of the immune system has led to the development of new approaches for cancer treatment. Currently, immune checkpoint inhibitors are the first successful examples of this approach and several agents that target cytotoxic lymphocyte-associated protein 4 (CTLA-4) and programmed cell death-1 (PD-1) have been approved for various oncologic situations. The aim of this review is to describe the neurologic adverse event profiles for these new immune therapeutic approaches and to discuss their appropriate management.
  
  
  
  The immune checkpoint inhibitor ipilimumab against CTLA-4 and nivolumab or pembrolizumab against PD-1 show a unique spectrum of toxic effects. The most common toxicities include rash, colitis, hepatitis, endocrinopathies, and pneumonitis. Neurologic side-effects are rare but include cases of immune polyneuropathies, Guillain Barré syndrome, myasthenia gravis, posterior reversible encephalopathy syndrome, aseptic meningitis, enteric neuropathy, transverse myelitis as well as immune encephalitis.
  
  
  
  It is essential that neurologic immune-related adverse events are recognized and treated as soon as possible, as early treatment increases the odds of a complete recovery.
authors.affiliation: Department of Clinical Neurosciences; Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland.
authors.forename: Andreas F
authors.initials: AF
authors.lastname: Hottinger
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use; D020275:Guillain-Barre Syndrome / Q000139:chemically induced*; D006801:Humans; D000074324:Ipilimumab / Q000009:adverse effects* / Q000627:therapeutic use; D009157:Myasthenia Gravis / Q000139:chemically induced*; D009369:Neoplasms / Q000188:drug therapy*; D000077594:Nivolumab; D011115:Polyneuropathies / Q000139:chemically induced*; D054038:Posterior Leukoencephalopathy Syndrome / Q000139:chemically induced*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000074324:Ipilimumab; D000077594:Nivolumab; C582435:pembrolizumab