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Rev Neurol ; 68(7): 301-311, 2019 Apr 01.
Article in Spanish | MEDLINE | ID: mdl-30906980

ABSTRACT

INTRODUCTION: Checkpoint inhibitors have dramatically transformed cancer treatment. However, due to the increasing number of tumors in which they are used, there is a high number of reported adverse effects. Among them, we highlight neurological side effects. In the approbatory clinical trials, they were thought to be sparse, but they may have been underestimated. AIM: To review the physiopathology and the incidence of neurological side effects due to the use of checkpoint inhibitors, as well as the clinical practice guidelines published in the last years. DEVELOPMENT: To review the published case reports of neurological side effects since the approval of checkpoint inhibitors, and our own experience. Moreover, we summarize the main clinical practice guidelines. CONCLUSIONS: Checkpoint inhibitors neurological side effects are frequent. A wide variety of central or peripheral nervous system symptoms may develop. In the setting of brain tumors, inflammation due to immune system activation might lead to pseudoprogression. Further studies are needed to better describe these neurological side effects, and to implement clinical guidelines.


TITLE: Complicaciones neurologicas de los inhibidores de punto de control inmunologico.Introduccion. Los inhibidores de punto de control inmunologico han supuesto un nuevo paradigma en el tratamiento de diferentes tipos de neoplasias. Sin embargo, con el uso creciente de estos farmacos, se estan observando diferentes efectos adversos. Entre ellos destacan los neurologicos, puesto que su frecuencia parece haberse infraestimado en los ensayos aprobatorios. Objetivo. Revisar la fisiopatologia y la incidencia de los efectos adversos neurologicos por inhibidores de punto de control neurologicos, asi como el abordaje basandose en diferentes guias clinicas. Desarrollo. Se revisan los casos que se han publicado desde la aprobacion de los farmacos y añadimos la experiencia de nuestro centro. A su vez, se hace un resumen de las diferentes guias publicadas de forma reciente. Conclusiones. Las complicaciones derivadas del uso de los inhibidores de punto de control inmunologico son frecuentes. Incluyen multiples cuadros de diferente gravedad, y pueden afectar a cualquier parte del sistema nervioso central y periferico. Ademas, en tumores del sistema nervioso, puede observarse un fenomeno de pseudoprogresion derivado de la inflamacion asociada. Queda pendiente realizar nuevos estudios para conocer en detalle estos efectos adversos y desarrollar guias clinicas con las que optimizar el manejo.


Subject(s)
Antineoplastic Agents/adverse effects , B7-H1 Antigen/antagonists & inhibitors , CTLA-4 Antigen/antagonists & inhibitors , Immunotherapy , Molecular Targeted Therapy , Neoplasm Proteins/antagonists & inhibitors , Neoplasms/drug therapy , Nervous System Diseases/chemically induced , Neuromuscular Diseases/chemically induced , Programmed Cell Death 1 Receptor/antagonists & inhibitors , Animals , Antineoplastic Agents/pharmacology , B7-H1 Antigen/physiology , Brain Neoplasms/drug therapy , Brain Neoplasms/immunology , CTLA-4 Antigen/deficiency , CTLA-4 Antigen/physiology , Clinical Trials as Topic , Humans , Immunotherapy/adverse effects , Mice , Mice, Knockout , Molecular Targeted Therapy/adverse effects , Neoplasm Proteins/physiology , Neoplasms/immunology , Nervous System Diseases/therapy , Neuromuscular Diseases/therapy , Practice Guidelines as Topic , Programmed Cell Death 1 Receptor/physiology
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