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Characteristics of immune checkpoint inhibitor-induced encephalitis and comparison with HSV-1 and anti-LGI1 encephalitis: a retrospective multicentre cohort study

AIM: Immune checkpoint inhibitor-induced encephalitis (ICI-iE) is a rare but life-threatening toxicity of immune checkpoint inhibitor treatment. We aim to identify the characteristics of ICI-iE and describe factors that discriminate it from herpes simplex virus (HSV)-1 encephalitis and anti-leucine-...

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Main Authors: Müller-Jensen, Leonie (Author) , Zierold, Sarah (Author) , Versluis, Judith M. (Author) , Boehmerle, Wolfgang (Author) , Huehnchen, Petra (Author) , Endres, Matthias (Author) , Mohr, Raphael (Author) , Compter, Annette (Author) , Blank, Christian U. (Author) , Hagenacker, Tim (Author) , Meier, Friedegund (Author) , Reinhardt, Lydia (Author) , Gesierich, Anja (Author) , Salzmann, Martin (Author) , Hassel, Jessica C. (Author) , Ugurel, Selma (Author) , Zimmer, Lisa (Author) , Banks, Patricia (Author) , Spain, Lavinia (Author) , Soon, Jennifer A. (Author) , Enokida, Tomohiro (Author) , Tahara, Makoto (Author) , Kähler, Katharina C. (Author) , Seggewiss-Bernhardt, Ruth (Author) , Harvey, Catriona (Author) , Long, Georgina V. (Author) , Schöberl, Florian (Author) , von Baumgarten, Louisa (Author) , Hundsberger, Thomas (Author) , Schlaak, Max (Author) , French, Lars E. (Author) , Knauss, Samuel (Author) , Heinzerling, Lucie M. (Author)
Format: Article (Journal)
Language:English
Published: 22 September 2022
In: European journal of cancer
Year: 2022, Volume: 175, Pages: 224-235
ISSN:1879-0852
DOI:10.1016/j.ejca.2022.08.009
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1016/j.ejca.2022.08.009
Verlag, kostenfrei, Volltext: https://www.sciencedirect.com/science/article/pii/S0959804922004865
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Author Notes:Leonie Müller-Jensen, Sarah Zierold, Judith M. Versluis, Wolfgang Boehmerle, Petra Huehnchen, Matthias Endres, Raphael Mohr, Annette Compter, Christian U. Blank, Tim Hagenacker, Friedegund Meier, Lydia Reinhardt, Anja Gesierich, Martin Salzmann, Jessica C. Hassel, Selma Ugurel, Lisa Zimmer, Patricia Banks, Lavinia Spain, Jennifer A. Soon, Tomohiro Enokida, Makoto Tahara, Katharina C. Kähler, Ruth Seggewiss-Bernhardt, Catriona Harvey, Georgina V. Long, Florian Schöberl, Louisa von Baumgarten, Thomas Hundsberger, Max Schlaak, Lars E. French, Samuel Knauss, Lucie M. Heinzerling
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Summary:AIM: Immune checkpoint inhibitor-induced encephalitis (ICI-iE) is a rare but life-threatening toxicity of immune checkpoint inhibitor treatment. We aim to identify the characteristics of ICI-iE and describe factors that discriminate it from herpes simplex virus (HSV)-1 encephalitis and anti-leucine-rich glioma-inactivated 1 (anti-LGI1) encephalitis, as two alternative entities of encephalitis. METHODS: In this retrospective multicentre cohort study, we collected patients with ICI-iE reported to the Side Effect Registry Immuno-Oncology from January 2015 to September 2021 and compared their clinical features and outcome with 46 consecutive patients with HSV-1 or anti-LGI1 encephalitis who were treated at a German neurological referral centre. RESULTS: Thirty cases of ICI-iE, 25 cases of HSV-1 encephalitis and 21 cases of anti-LGI1 encephalitis were included. Clinical presentation of ICI-iE was highly variable and resembled that of HSV-1 encephalitis, while impairment of consciousness (66% vs. 5%, p = .007), confusion (83% vs. 43%; p = .02), disorientation (83% vs. 29%; p = .007) and aphasia (43% vs. 0%; p = .007) were more common in ICI-iE than in anti-LGI1 encephalitis. Antineuronal antibodies (17/18, 94%) and MRI (18/30, 60%) were mostly negative in ICI-iE, but cerebrospinal fluid (CSF) showed pleocytosis and/or elevated protein levels in almost all patients (28/29, 97%). Three patients (10%) died of ICI-iE. Early immunosuppressive treatment was associated with better outcome (r = 0.43). CONCLUSIONS: ICI-iE is a heterogeneous entity without specific clinical features. CSF analysis has the highest diagnostic value, as it reveals inflammatory changes in most patients and enables the exclusion of infection. Early treatment of ICI-iE is essential to prevent sequelae and death.
Item Description:Gesehen am 14.06.2024
Physical Description:Online Resource
ISSN:1879-0852
DOI:10.1016/j.ejca.2022.08.009

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