2023 World Conference on Lung Cancer (Posters)-EP11.03. Characterizing Neurologic Immune-related Adverse Events Using Consensus Disease Definitions

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Neurologic immune-related adverse events (n-irAEs) are a major cause of morbidity and mortality in patients receiving immune checkpoint inhibitors (ICI) for non-small cell lung cancer (NSCLC). However, the lack of clear, standardized disease definitions for n-irAEs has led to misclassification and difficulties in managing patients. In 2021, expert consensus guidelines were published to provide disease definitions for n-irAEs, but their clinical application has not yet been assessed. <br /><br />This study aimed to assess the clinical application of the consensus disease definitions for n-irAEs in NSCLC patients treated at Massachusetts General Hospital (MGH). The researchers included adult patients who received ICIs and were treated for suspected n-irAEs between 2011 and 2020. Chart reviews were conducted to determine cancer type, treatment, and toxicity outcomes. Neurologists specializing in autoimmune disorders reviewed all cases for inclusion.<br /><br />Of the 70 patients who developed n-irAEs, 22.9% had NSCLC. Most patients were male, had an Eastern Cooperative Oncology Group (ECOG) score of 0-1, and were Caucasian. The majority had received either PD-1/PD-L1 monotherapy or combination ICI therapy. Peripheral nervous system (PNS) irAEs were observed in 61.0% of patients, while central nervous system (CNS) irAEs were seen in 35.1% of patients. Some patients experienced both CNS and PNS toxicity. The majority of n-irAEs were of grade 3 severity. Treatment outcomes varied, with some patients achieving complete or partial responses, while others had stable or progressive disease. Most patients required a dose delay or discontinuation, with a significant proportion discontinuing ICI therapy permanently.<br /><br />In conclusion, this study successfully applied the consensus disease definitions for n-irAEs in NSCLC patients. The findings reinforced patterns seen in other datasets, such as the early presentation of neurologic irAEs and the higher prevalence of PNS irAEs compared to CNS disorders. These toxicities were often severe and associated with high rates of ICI discontinuation. The study highlights the importance of accurate classification of n-irAEs for future interventional trials and outcomes research.

Asset Subtitle

Aliyah Pabani

Meta Tag

Speaker Aliyah Pabani

Topic Metastatic NSCLC: Immunotherapy - Retrospective

Keywords

neurologic immune-related adverse events

n-irAEs

morbidity

mortality

immune checkpoint inhibitors

non-small cell lung cancer

disease definitions

patient management

consensus guidelines

clinical application