{
  "abstract": "Background Immune checkpoint inhibitors (ICIs) are a leading treatment for cancer, however, little is known about how patients with neurologic autoimmune conditions respond to ICIs. 1 Here, we determine if a relationship exists between ICI use and neurologic autoimmune disease exacerbations.Methods Patients with a history of pre-existing autoimmune neurologic disorders and ICI use were identified. Overall survival (OS) was defined as time from ICI initiation to death. Progression-free survival (PFS) was defined as time from ICI initiation to disease progression, recurrence, or death. Treatment-free survival (TFS) was defined as the time interval from the completion of first-line treatment to initiation of second-line therapy. Survivor distributions for OS, PFS, and TFS were estimated using the Kaplan-Meier method, and differences between groups were assessed using the Log-Rank test.Results Eighteen patients met criteria for the study. Upon ICI initiation, patients were on average 66 years old, predominantly female (61%), had advanced cancer (stage IV- 71%), and had lung cancer (53%, 17% small cell lunger cancer, table 1). The cohort included patients with multiple sclerosis (MS) (12), autoimmune encephalitis (AE) (2), acute or chronic inflammatory demyelinating polyneuropathy (AIDP/CIDP) (2), myasthenia gravis (MG) (1), and idiopathic transverse myelitis (ITM) (1). Five patients were on disease modifying therapy at the time of ICI initiation (4 patients with MS, 1 patient with MG). The objective response rate was 56% (5% complete recovery, 51% partial recovery). 33% of patients had an irAE. One patient with underlying MG had a myasthenic crisis after IO initiation. The probability of TFS at 1 year was 26% (95% CI: 0.05, 0.55) and patients with an irAE had 7.4-fold higher hazard of having 2nd line treatment (hazard ratio (HR)= 7.4, 95% confidence interval (CI) 1.19-45.64, p=0.03). The probabilities of OS at 1-year and 2-year were 81% (95% CI: 0.51, 0.93) and 43% (95% CI: 0.12, 0.7) and patients with an irAE had 23-fold higher hazard of dying (HR=23, 95% CI 0.70-749.33, p=0.07). The probability of PFS at 1 year was 27 (95% CI: 0.09, 0.5) and patients with an irAE had 2-fold higher hazard of progression or death (HR=2.1, 95% CI 0.67-6.85, p=0.2).Conclusions Only one patient with a pre-existing autoimmune condition had an exacerbation of their neurologic disease. Our results suggest that ICIs may safely be used in patients with underlying stable neurologic autoimmune disease. Further studies are required to optimize ICI therapy in this cohort.Reference Hirunpattarasilp C, Fu P, Margevicius SP, Mirsky M, Bruno D, Mangla A, Hoehn RS, Rothermel LD, Sheng IY. Outcomes in patients with multiple sclerosis and solid organ cancers treated with immune checkpoint inhibitors. Neurooncol Adv. 2025 Mar 4;7(1):vdaf048. doi: 10.1093/noajnl/vdaf048. PMID: 40264941; PMCID: PMC12012678.Abstract 404 Table 1Demographic characteristics",
  "authors": [
    {
      "affiliations": [
        "University Hospitals, Cleveland, OH, USA"
      ],
      "name": "Shlok Sarin"
    },
    {
      "affiliations": [
        "University Hospitals, Cleveland, OH, USA"
      ],
      "name": "Roshni Kailar"
    },
    {
      "affiliations": [
        "University Hospitals, Cleveland, OH, USA"
      ],
      "name": "Chanawee Hirunpattarsilp"
    },
    {
      "affiliations": [
        "University Hospitals, Cleveland, OH, USA"
      ],
      "name": "Katherine Myers"
    },
    {
      "affiliations": [
        "Case Western Reserve University, Cleveland, OH, USA"
      ],
      "name": "Seunghee Margevicius"
    },
    {
      "affiliations": [
        "Case Western Reserve University, Cleveland, OH, USA"
      ],
      "name": "Pingfu Fu"
    },
    {
      "affiliations": [
        "University Hospitals, Cleveland, OH, USA"
      ],
      "name": "Hesham Abboud"
    },
    {
      "affiliations": [
        "University Hospitals Seidman Cancer Center, Cleveland, OH, USA"
      ],
      "name": "Matthew Mirsky"
    },
    {
      "affiliations": [
        "University Hospitals Seidman Cancer Center, Cleveland, OH, USA"
      ],
      "name": "Iris Y Sheng"
    }
  ],
  "title": "404 Use of immune checkpoint inhibitors in patients with a prior history of neurologic autoimmune disease: a retrospective cohort study",
  "uid": "5f72caa0-3031-556a-9bbc-dfa68710a8b2"
}