par Duvigneaud, Zachary 
;Ilzkovitz, M.;Wolff, Louis ;Meert, Anne-Pascale ;Ferlini, Lorenzo
Référence Revue médicale de Bruxelles, 47, Special Issue, page (86-95)
Publication Publié, 2026-10-01
;Ilzkovitz, M.;Wolff, Louis ;Meert, Anne-Pascale ;Ferlini, Lorenzo Référence Revue médicale de Bruxelles, 47, Special Issue, page (86-95)
Publication Publié, 2026-10-01
Article révisé par les pairs
| Résumé : | Immune checkpoint inhibitors (ICI) have transformed cancer treatment, but they can induce rare yet severe central neurological immune-related adverse events (irAE), which can be life-threatening. A comprehensive literature review was conducted to characterize the clinical spectrum, diagnostic approach, and therapeutic strategies associated with central neurological toxicities caused by ICI. Central irAEs include aseptic meningitis, autoimmune encephalitis, paraneoplastic syndromes, vasculitis, demyelinating lesions, and, more rarely, posterior reversible encephalopathy syndrome (PRES). These complications usually occur within weeks of initiating ICI. Diagnosis relies on clinical assessment, brain imaging, cerebrospinal fluid analysis, and autoantibody screening. First-line therapy includes corticosteroids, with IV immunoglobulins or plasmapheresis added in severe cases. In resistant forms, escalation to immunosuppressive agents such as rituximab or cyclophosphamide may be necessary. The safety of ICI rechallenge remains uncertain and should be guided by initial toxicity severity and response to treatment. Early recognition and prompt management of ICI-induced central neurological toxicities are crucial to reduce morbidity. A structured diagnostic approach and multidisciplinary collaboration are essential. Further research is needed to optimize rechallenge strategies. |
