{
  "abstract": "Background The unique mechanism of action of immune checkpoint inhibitors (ICI) can lead to auto-inflammatory events, potentially involving any organ. Among those, different rare immune related adverse events (irAEs) have also been identified, with Neurological irAEs (NirAEs) accounting for 1-5%. In this scenario, we here report the 10-year experience of the multidisciplinary team at the University Hospital of Siena, Italy, in the diagnosis and clinical management of NirAEs.Methods A case series of ICI-treated patients with clinical suspect of Nir-AEs were evaluated by an experienced neurologist team. Neurological specific antibodies were tested in central/peripheral toxicities. In case of suspicious of CNS NirAEs, lumbar puncture was utilized to exclude infectious/paraneoplastic causes. In patients with signs and symptoms suggestive for myositis, a diagnostic muscular biopsy was performed.Results From January 2012 to December 2022, 1328 patients with solid tumors were treated with ICI, and 24 (1,8%) were diagnosed with NirAEs: peripheral, central, or both in 20, 1, and 3 cases respectively. The most representative neurotoxicity was muscular/neuromuscular junction involvement. Histological examination of muscle biopsies depicted two main pathological patterns: highly inflammatory or necrotizing. NirAEs were Grade (G) 1-2 (11), G3-4 (10), G5 (3) and were treated with steroids, immunoglobulins and/or plasma exchange. Treatment led to complete or partial recovery of NirAEs in 11 (46%) and 10 patients (42%), respectively. In 3 cases NirAEs progressively worsened and patients died thereafter.Conclusions Our long-term experience indicates that a multidisciplinary approach avoids worsening of NirAEs leading to clinical recovery in the large majority of ICI-treated patients.",
  "authors": [
    {
      "affiliations": [
        "University of Siena, Siena, Italy",
        "Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Siena, Italy"
      ],
      "name": "Anna Maria Di Giacomo"
    },
    {
      "affiliations": [
        "Neurology and Clinical Neurophysiology Unit, Department of Medical, Surgery and Neurological Sciences, University Hospital of Siena, Siena, Italy"
      ],
      "name": "Sabina Bartalini"
    },
    {
      "affiliations": [
        "University of Siena, Siena, Italy"
      ],
      "name": "Vincenzo D’Alonzo"
    },
    {
      "affiliations": [
        "Diagnostic and Therapeutic Neuroradiology Unit, University Hospital of Siena, Siena, Italy"
      ],
      "name": "Alfonso Cerase"
    },
    {
      "affiliations": [
        "University of Siena, Siena, Italy"
      ],
      "name": "Serena Cutarella"
    },
    {
      "affiliations": [
        "Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Siena, Italy"
      ],
      "name": "Giulia Rossi"
    },
    {
      "affiliations": [
        "Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Siena, Italy"
      ],
      "name": "Monica Valente"
    },
    {
      "affiliations": [
        "University of Siena, Siena, Italy"
      ],
      "name": "Matteo Ravara"
    },
    {
      "affiliations": [
        "Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Siena, Italy",
        "University of Siena, Monteriggioni, Italy"
      ],
      "name": "Maura Colucci"
    },
    {
      "affiliations": [
        "University of Siena, Siena, Italy"
      ],
      "name": "Giulia Gibilisco"
    },
    {
      "affiliations": [
        "Neurology Unit, San Donato Hospital, Arezzo, Italy"
      ],
      "name": "Laura Insana"
    },
    {
      "affiliations": [
        "Neurology Unit, Misericordia Hospital, Grosseto, Italy"
      ],
      "name": "Silvia Bocci"
    },
    {
      "affiliations": [
        "University of Siena, Siena, Italy"
      ],
      "name": "Valentina Croce"
    },
    {
      "affiliations": [
        "University of Siena, Siena, Italy"
      ],
      "name": "Tommaso Sani"
    },
    {
      "affiliations": [
        "University of Siena, Siena, Italy"
      ],
      "name": "Eleonora Carbonari"
    },
    {
      "affiliations": [
        "Neurology and Clinical Neurophysiology Unit, Department of Medical, Surgery and Neurological Sciences, University Hospital of Siena, Siena, Italy"
      ],
      "name": "Fabio Giannini"
    },
    {
      "affiliations": [
        "Neurology and Clinical Neurophysiology Unit, Department of Medical, Surgery and Neurological Sciences, University Hospital of Siena, Siena, Italy"
      ],
      "name": "Nila Volpi"
    },
    {
      "affiliations": [
        "Neurology and Clinical Neurophysiology Unit, Department of Medical, Surgery and Neurological Sciences, University Hospital of Siena, Siena, Italy"
      ],
      "name": "Federica Ginanneschi"
    },
    {
      "affiliations": [
        "University of Siena, Siena, Italy",
        "Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Siena, Italy"
      ],
      "name": "Michele Maio"
    }
  ],
  "title": "1049 Neurological adverse events of ICI therapy: a ten-year comprehensive management from a multidisciplinary team",
  "uid": "35134113-e377-51ad-b8e1-2607d0e4146c"
}